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Organization

EYE DOC INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. LOUIS J STANLEY OD (PRESIDENT)
(304) 344-0162
Entity
Organization

Contact information

Practice address
100 NITRO MARKETPLACE, NITRO, WV 25143
(304) 769-2253
(304) 769-2254
Mailing address
1542 THOMAS CIR, CHARLESTON, WV 25314-1623
(304) 344-0162
(304) 769-2254

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
WV859OD
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
EY9289823
MEDICARE GROUP NUMBER
WV
Enumeration date
05/18/2006
Last updated
10/31/2012
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