Martin B. Gresak , O.D.

Primary specialty

Corneal and Contact Management OptometristTaxonomy code 152WC0802X

License

748-OD Issued in WV

Legal business name

MARTIN B. GRESAK , O.D.

Doing business as

family vision clinic

Practice address

301 Jefferson Ave
Moundsville, WV 26041-1639

Phone

(304) 845-2590

NPI assigned

Sep 25, 2007

Organization subpart

No

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

Authorized official

Name

Martin B Gresak, ODNPI 1417952037

Title

Owner

Phone

(304) 599-2828

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• family vision clinic Doing business as

Locations

Practitioners 1

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

• Martin B Gresak, O.D.

  • Corneal and Contact Management Optometrist
  • Morgantown, WV
  • NPI 1417952037
  NPD (past) Authorized official

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

{
    "created_epoch": "1190678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199750400000",
    "number": "1215124169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 JEFFERSON AVE",
            "city": "MOUNDSVILLE",
            "state": "WV",
            "postal_code": "26041",
            "telephone_number": "304-845-2590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 JEFFERSON AVE",
            "city": "MOUNDSVILLE",
            "state": "WV",
            "postal_code": "260411639",
            "telephone_number": "304-845-2590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTIN B. GRESAK , O.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-25",
        "last_updated": "2008-01-08",
        "status": "A",
        "authorized_official_last_name": "GRESAK",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-599-2828",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "WV",
            "license": "748-OD",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0150739000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PLAN",
            "identifier": "748",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MTN ST BC/BS",
            "identifier": "000171370",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "family vision clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marshall County Health Department
• Marshall County Health Department
• Marshall County Health Department
• Marshall County Health Department
• Marshall County Senior Center
• Julie Rose Mason
• Trent Glen Mason, MD
• Michelle Rae Masters-Lynch
• Melinda Dawn Masters
• Tara Renee Matts

• Corneal and Contact Management Optometrist in Moundsville, WV
• Providers in Moundsville, WV by specialty
• Corneal and Contact Management Optometrist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.