Provider Demographics
NPI:1740323625
Name:BECKLEY VISION CENTER, PLLC
Entity type:Organization
Organization Name:BECKLEY VISION CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOLLIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-252-1299
Mailing Address - Street 1:1928 HARPER RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2612
Mailing Address - Country:US
Mailing Address - Phone:304-252-1299
Mailing Address - Fax:304-253-4079
Practice Address - Street 1:1928 HARPER RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2612
Practice Address - Country:US
Practice Address - Phone:304-252-1299
Practice Address - Fax:304-253-4079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV817-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810006176Medicaid
WV3810006176Medicaid
WV9314511Medicare PIN