Provider Demographics
NPI:1205998648
Name:REGIONAL EYE ASSOCIATES, INC
Entity type:Organization
Organization Name:REGIONAL EYE ASSOCIATES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-598-3301
Mailing Address - Street 1:1255 PINEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2713
Mailing Address - Country:US
Mailing Address - Phone:304-598-3301
Mailing Address - Fax:304-599-7346
Practice Address - Street 1:1299 PINEVIEW DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505
Practice Address - Country:US
Practice Address - Phone:304-598-5777
Practice Address - Fax:304-598-5754
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGIONAL EYE ASSOCIATES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-14
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0007123001Medicaid
5110111Medicare ID - Type Unspecified