Provider Demographics
NPI:1841441078
Name:OPTICAL 101 PLLC
Entity type:Organization
Organization Name:OPTICAL 101 PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:FICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-296-2540
Mailing Address - Street 1:499 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-5516
Mailing Address - Country:US
Mailing Address - Phone:304-296-2540
Mailing Address - Fax:304-296-2542
Practice Address - Street 1:499 HIGH ST
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-5516
Practice Address - Country:US
Practice Address - Phone:304-296-2540
Practice Address - Fax:304-296-2542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1008-OD261Q00000X
WV1009-OD261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center