Provider Demographics
NPI:1932318052
Name:JEFFERY E. GATES, OD
Entity Type:Organization
Organization Name:JEFFERY E. GATES, OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-623-2892
Mailing Address - Street 1:552 EMILY DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-5508
Mailing Address - Country:US
Mailing Address - Phone:304-623-2892
Mailing Address - Fax:304-622-2809
Practice Address - Street 1:552 EMILY DR
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-5508
Practice Address - Country:US
Practice Address - Phone:304-623-2892
Practice Address - Fax:304-622-2809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV 909-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0149812001Medicaid
WV0149812000Medicaid
WVU33029Medicare UPIN
WV9312951Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
WV0149812000Medicaid