Organization
MODERNEYES, PLLC
Active
Parent organization
MODERNEYES, PLLC
Other names
Charleston Vision Source
Organization subpart
Yes
Provider details
NPI number
Legal business name
MODERNEYES, PLLC
Authorized official
DR. LAURA M SUPPA SAMMONS OD (OPTOMETRIST)
(304) 545-8366
Entity
Organization
Contact information
Practice address
4202 MACCORKLE AVE SE, CHARLESTON, WV 25304-2502
(304) 925-4761
Mailing address
1171 CREEKSTONE RDG, SOUTH CHARLESTON, WV 25309-9476
(304) 545-8366
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3910005909
—
WV
Enumeration date
10/15/2021
Last updated
05/25/2023
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