Rebecca St Jean OD Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

989-OD Issued in WV

Legal business name

REBECCA ST JEAN OD INC

Practice address

4030 Maccorkle Ave SW
South Charleston, WV 25309-1510

Phone

(304) 766-2220

Fax

(304) 766-0824

NPI assigned

Apr 29, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Rebecca V St. Jean, O.D.NPI 1215922174

Title

Owner

Phone

(304) 766-2220

Specialties & licenses 1

Addresses

Other names 1

• Advanced Eye Care Center Doing business as

Medicare fee-for-service enrollment

Enrolled in WV

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rebecca V St Jean, OD

  • Optometrist
  • South Charleston, WV
  • NPI 1215922174
  Medicare reassignment Care Compare group NPD Authorized official
• Elicia Beth Miller, O.D.

  • Optometrist
  • South Charleston, WV
  • NPI 1144410176
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1209427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352073600000",
    "number": "1053586008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4030 MACCORKLE AVE SW",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091510",
            "telephone_number": "304-766-2220",
            "fax_number": "304-766-0824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4030 MACCORKLE AVE SW",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091510",
            "telephone_number": "304-766-2220",
            "fax_number": "304-766-0824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REBECCA ST JEAN OD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-29",
        "last_updated": "2012-11-05",
        "status": "A",
        "authorized_official_last_name": "ST. JEAN",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-766-2220",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WV",
            "license": "989-OD",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Eye Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Janice Ray
• Natasha Ray
• Tara Fawn Ray, DO
• Madalynn Marie Raynor, PA-C
• Victoria Reavis
• Recover & Rebuild Counseling, LLC
• Susmitha Marri Reddy, M B B S FRCR
• Samantha Redmond
• Cassandra Reed
• Cindy Reed

• Optometrist in South Charleston, WV
• Providers in South Charleston, WV by specialty
• Optometrist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.