Randolph County Eye Care Center PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

WV93800 Issued in WV

Legal business name

RANDOLPH COUNTY EYE CARE CENTER PC

Practice address

RT 250/219 Chenoweth Creek Rd
Elkins, WV 26241

Phone

(304) 636-3887

Fax

(304) 636-0538

NPI assigned

Oct 4, 2006

Last updated

Apr 2, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jenna Louise Gongola, ODNPI 1194810242

Title

President Optometrist

Phone

(304) 636-3887

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WV

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kevin Robert Lambert, OD

  • Optometrist
  • Elkins, WV
  • NPI 1194379479
  Medicare reassignment NPD
• Jenna Louise Gongola, OD

  • Optometrist
  • Elkins, WV
  • NPI 1194810242
  Authorized official Same address or phone

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207094400000",
    "number": "1780779835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1489",
            "city": "ELKINS",
            "state": "WV",
            "postal_code": "26241",
            "telephone_number": "304-636-3887",
            "fax_number": "304-636-0538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "RT 250/219 CHENOWETH CREEK RD",
            "city": "ELKINS",
            "state": "WV",
            "postal_code": "26241",
            "telephone_number": "304-636-3887",
            "fax_number": "304-636-0538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANDOLPH COUNTY EYE CARE CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2008-04-02",
        "status": "A",
        "authorized_official_last_name": "GONGOLA",
        "authorized_official_first_name": "JENNA",
        "authorized_official_middle_name": "LOUISE",
        "authorized_official_title_or_position": "PRESIDENT OPTOMETRIST",
        "authorized_official_telephone_number": "304-636-3887",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "WV",
            "license": "WV93800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0012694000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa Raines
• Jacqueline D Ramsey
• Randolph County Board of Education
• Randolph County Board of Education
• Randolph County Court Emergency Squad
• Randolph Elkins Health Department
• Randolph Elkins Health Department
• Michelle Lynn Ratnakar, PA-C
• Nitesh Ratnakar, M.D.; FACG
• Andrew Ray

• Optometrist in Elkins, WV
• Providers in Elkins, WV by specialty
• Optometrist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2008; 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.