NPIMap

Organization Active NPI

Mountain State Eye Associates, PLLC

  • Ophthalmology Physician
  • Charleston, WV
National Provider Identifier
1437493319
Registry record updated Dec 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
WV21067 Issued in WV
Legal business name
MOUNTAIN STATE EYE ASSOCIATES, PLLC
Practice address
1306 Kanawha Blvd East
Charleston, WV 25301-3001
Phone
(304) 353-0304
Fax
(304) 353-0218
NPI assigned
Nov 16, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2012

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

Authorized official

Name
Mrs. Anne Elizabeth Bounds
Title
Office Manager
Phone
(304) 353-0222

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X WV8200D WV
Ophthalmology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207W00000X WV20725 WV
Ophthalmology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207W00000X WV21067 WV Primary

Addresses

Primary practice location

1306 Kanawha Blvd East
Charleston, WV 25301-3001

Mailing address

PO Box 5308
Charleston, WV 25361-0308
Phone (304) 353-0304

Other identifiers 3

IdentifierTypeStateIssuer
0149311000MedicaidWV
3810005917MedicaidWV
2004585000MedicaidWV

National Provider Directory

National Provider Directory

Locations

211 Sunset Dr
Beckley, WV 25801
Phone (304) 255-4522

NPI Registry JSON

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

{
    "created_epoch": "1353024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354665600000",
    "number": "1437493319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5308",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253610308",
            "telephone_number": "304-353-0304",
            "fax_number": "304-353-0218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1306 KANAWHA BLVD EAST",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253013001",
            "telephone_number": "304-353-0304",
            "fax_number": "304-353-0218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN STATE EYE ASSOCIATES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-16",
        "last_updated": "2012-12-05",
        "status": "A",
        "authorized_official_last_name": "BOUNDS",
        "authorized_official_first_name": "ANNE",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "304-353-0222",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "WV",
            "license": "WV8200D",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "WV",
            "license": "WV20725",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "WV",
            "license": "WV21067",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0149311000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810005917",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2004585000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2012; 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.