Organization
DR. EDDIE PRENDERGAST OD
Active
Other names
Dr. Eddie Prendergast OD
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDDIE LEO PRENDERGAST JR. OD (OWNER)
(304) 872-5678
Entity
Organization
Contact information
Practice address
651 WATER ST, SUMMERSVILLE, WV 26651-1454
(304) 872-5678
(307) 872-5697
Mailing address
651 WATER ST, SUMMERSVILLE, WV 26651-1454
(304) 872-5678
(307) 872-5697
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
666D
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0150410000
—
WV
Enumeration date
10/01/2008
Last updated
11/07/2008
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