Provider Demographics
NPI:1841343779
Name:DR. KRESS EYECARE ASSOCIATES, PLLC
Entity type:Organization
Organization Name:DR. KRESS EYECARE ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:D
Authorized Official - Last Name:KRESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-472-1235
Mailing Address - Street 1:100 W MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-2237
Mailing Address - Country:US
Mailing Address - Phone:304-472-1235
Mailing Address - Fax:304-472-1245
Practice Address - Street 1:100 W MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-2237
Practice Address - Country:US
Practice Address - Phone:304-472-1235
Practice Address - Fax:304-472-1245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001710926OtherBCBS
WV4000412001Medicaid
WVDD7301OtherRAILROAD
WV1314480001Medicare NSC
WV9306092Medicare PIN