Provider Demographics
NPI:1831161322
Name:THE EYE CENTER OF GREENBRIER VALLEY
Entity type:Organization
Organization Name:THE EYE CENTER OF GREENBRIER VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:N
Authorized Official - Last Name:LIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-793-3937
Mailing Address - Street 1:101 DAVIS STUART RD
Mailing Address - Street 2:
Mailing Address - City:RONCEVERTE
Mailing Address - State:WV
Mailing Address - Zip Code:24970-9549
Mailing Address - Country:US
Mailing Address - Phone:304-793-3937
Mailing Address - Fax:304-793-2203
Practice Address - Street 1:101 DAVIS STUART RD
Practice Address - Street 2:
Practice Address - City:RONCEVERTE
Practice Address - State:WV
Practice Address - Zip Code:24970-9549
Practice Address - Country:US
Practice Address - Phone:304-793-3937
Practice Address - Fax:304-793-2203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVF25588332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0095836003Medicaid
WV0751242Medicare ID - Type UnspecifiedPROVIDER NUMBER
WV0095836003Medicaid