Organization
MOUNTAIN STATE EYE ASSOCIATES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANNE ELIZABETH BOUNDS (OFFICE MANAGER)
(304) 353-0222
Entity
Organization
Contact information
Practice address
1306 KANAWHA BLVD EAST, CHARLESTON, WV 25301-3001
(304) 353-0304
(304) 353-0218
Mailing address
PO BOX 5308, CHARLESTON, WV 25361-0308
(304) 353-0304
(304) 353-0218
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
WV8200D
WV
207W00000X
Ophthalmology Physician
WV20725
WV
207W00000X
Ophthalmology Physician
Primary
WV21067
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0149311000
—
WV
05
—
2004585000
—
WV
05
—
3810005917
—
WV
Enumeration date
11/16/2012
Last updated
12/05/2012
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