Provider Demographics
NPI:1649293473
Name:BLUE RIDGE EYE CARE, INC.
Entity type:Organization
Organization Name:BLUE RIDGE EYE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:INMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-327-0207
Mailing Address - Street 1:PO BOX 7202
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-7202
Mailing Address - Country:US
Mailing Address - Phone:304-327-0207
Mailing Address - Fax:304-324-0908
Practice Address - Street 1:US HWY 460 ST RT 25
Practice Address - Street 2:MERCER MALL
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701
Practice Address - Country:US
Practice Address - Phone:304-327-0207
Practice Address - Fax:304-324-0908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV993-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVCH4381OtherUNITED HEALTHCARE GROUP
WVCH4381OtherUNITED HEALTHCARE GROUP