Organization
THE EYE SHOP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAWN BERARDI (OWNER)
(304) 598-4888
Entity
Organization
Contact information
Practice address
1 MEDICAL CENTER DR, MORGANTOWN, WV 26506-1200
(304) 598-4888
Mailing address
1 MEDICAL CENTER DR, MORGANTOWN, WV 26506-1200
(304) 598-4888
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202588917
TAX ID
WV
01
—
233170297
SS#
MD
01
—
83145721
TAX ID
WV
Enumeration date
10/29/2018
Last updated
10/29/2018
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