Organization
FAIRMONT EYE CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILIP MARC WILMOTH OD (PRESIDENT DOCTOR)
(304) 366-4721
Entity
Organization
Contact information
Practice address
709 MORGANTOWN AVE, FAIRMONT, WV 26554
(304) 366-4721
(304) 366-4847
Mailing address
709 MORGANTOWN AVE, FAIRMONT, WV 26554-4331
(304) 366-4721
(304) 366-4847
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015096400
—
WV
01
—
CM3317
RAILROAD MEDICARE
WV
Enumeration date
04/11/2006
Last updated
12/22/2009
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