Organization
JEFFERY E. GATES, OD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFERY EUGENE GATES OD (OWNER)
(304) 623-2892
Entity
Organization
Contact information
Practice address
552 EMILY DR, CLARKSBURG, WV 26301-5508
(304) 623-2892
(304) 622-2809
Mailing address
552 EMILY DR, CLARKSBURG, WV 26301-5508
(304) 623-2892
(304) 622-2809
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
WV 909-OD
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0149812000
—
WV
05
—
0149812001
—
WV
Enumeration date
05/22/2007
Last updated
08/22/2020
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