Provider Demographics
NPI:1750378790
Name:DECARIA, FRANK SALVATORE (OD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:SALVATORE
Last Name:DECARIA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3065 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-4709
Mailing Address - Country:US
Mailing Address - Phone:304-748-5230
Mailing Address - Fax:304-748-2123
Practice Address - Street 1:3065 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-4709
Practice Address - Country:US
Practice Address - Phone:304-748-5230
Practice Address - Fax:304-748-2123
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWVD611152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0150654000Medicaid
9149241Medicare ID - Type Unspecified
WV0150654000Medicaid