Provider Demographics
NPI:1982982625
Name:WESTOVER EYE ASSOCIATES PLLC
Entity Type:Organization
Organization Name:WESTOVER EYE ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:G
Authorized Official - Last Name:BERARDI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-825-6364
Mailing Address - Street 1:3208 HUSKY HWY.
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26571
Mailing Address - Country:US
Mailing Address - Phone:304-825-6364
Mailing Address - Fax:
Practice Address - Street 1:3208 HUSKY HWY
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:WV
Practice Address - Zip Code:26571-8122
Practice Address - Country:US
Practice Address - Phone:304-825-6364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
WV1071-00152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810007303Medicaid