Provider Demographics
NPI:1780876888
Name:JOSEPH AUDIA, OD
Entity type:Organization
Organization Name:JOSEPH AUDIA, OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST / PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:AUDIA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-643-2117
Mailing Address - Street 1:1403 E PEARL ST
Mailing Address - Street 2:
Mailing Address - City:HARRISVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26362-9759
Mailing Address - Country:US
Mailing Address - Phone:304-643-2117
Mailing Address - Fax:304-643-2116
Practice Address - Street 1:1403 E PEARL ST
Practice Address - Street 2:
Practice Address - City:HARRISVILLE
Practice Address - State:WV
Practice Address - Zip Code:26362-9759
Practice Address - Country:US
Practice Address - Phone:304-643-2117
Practice Address - Fax:304-643-2116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0781-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV015081300Medicaid
WV015081300Medicaid
0128910002Medicare NSC
AU12461Medicare UPIN