Organization Active NPI

Family Vision Care Inc

  • Optometrist
  • Fayetteville, WV
National Provider Identifier
1124340559
Registry record updated Apr 25, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1042-OD Issued in WV
Legal business name
FAMILY VISION CARE INC
Practice address
100 Fayette Town Ctr
Fayetteville, WV 25840-9539
Phone
(304) 574-3557
NPI assigned
Feb 26, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2010

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

Authorized official

Name
Dr. William E Pugh III, ODNPI 1821289745
Title
Optometrist
Phone
(303) 640-4258

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 1042-OD WV Primary

Addresses

Primary practice location

100 Fayette Town Ctr
Fayetteville, WV 25840-9539

Mailing address

100 Fayette Town Ctr
Fayetteville, WV 25840-9539
Phone (304) 574-3557

Other identifiers 1

IdentifierTypeStateIssuer
3810016948MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100427000200 WV Part B Supplier - Clinic/Group Practice 2264569094 Receives reassigned benefits from 4 practitioners
Practice locations: Macarthur, WV; Summersville, WV; Lewisburg, WV; Fayetteville, WV; Beckley, WV

National Provider Directory

National Provider Directory

Locations

100 Town Center Rd
Fayetteville, WV 25840
Phone (304) 574-1283

2700 Mountaineer Blvd
South Charleston, WV 25309
Phone (304) 744-2261

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1267142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1272153600000",
    "number": "1124340559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 FAYETTE TOWN CTR",
            "city": "FAYETTEVILLE",
            "state": "WV",
            "postal_code": "258409539",
            "telephone_number": "304-574-3557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 FAYETTE TOWN CTR",
            "city": "FAYETTEVILLE",
            "state": "WV",
            "postal_code": "258409539",
            "telephone_number": "304-574-3557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY VISION CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-26",
        "last_updated": "2010-04-25",
        "status": "A",
        "authorized_official_last_name": "PUGH",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "303-640-4258",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WV",
            "license": "1042-OD",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810016948",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2010; 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.