Organization
RANDOLPH COUNTY EYE CARE CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNA LOUISE GONGOLA OD (PRESIDENT OPTOMETRIST)
(304) 636-3887
Entity
Organization
Contact information
Practice address
RT 250/219 CHENOWETH CREEK RD, ELKINS, WV 26241
(304) 636-3887
(304) 636-0538
Mailing address
PO BOX 1489, ELKINS, WV 26241
(304) 636-3887
(304) 636-0538
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
WV93800
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012694000
—
WV
Enumeration date
10/04/2006
Last updated
04/02/2008
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