Organization
FAMILY EYEDOCTORS PLLC
Active
Other names
Family EyeDoctors
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JILL SHOWALTER (OWNER)
(304) 295-5025
Entity
Organization
Contact information
Practice address
1500 GRAND CENTRAL AVE STE 112, VIENNA, WV 26105-1079
(304) 295-5025
Mailing address
1500 GRAND CENTRAL AVE STE 112, VIENNA, WV 26105-1079
(304) 295-5025
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
939-OD
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A530
MEDICARE PTAN
WV
Enumeration date
03/28/2011
Last updated
10/20/2020
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