Individual provider Active NPI

Marlene B Mowery, OD

  • Optometrist
  • Charleston, WV
National Provider Identifier
1831139419
Registry record updated Nov 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
WV8200D Issued in WV
Practice address
1306 Kanawha Blvd E
Charleston, WV 25301-3001
Phone
(304) 343-4371
Fax
(304) 343-0215
NPI assigned
Jun 8, 2006
Last updated
Nov 4, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X WV8200D WV Primary

Addresses

Primary practice location

1306 Kanawha Blvd E
Charleston, WV 25301-3001

Mailing address

1650 Woodvale Dr
Charleston, WV 25314-2547
Phone (304) 343-4371

Other identifiers 1

IdentifierTypeStateIssuer
0149311000MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040315000172 WV Practitioner - Optometry 6608765920 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
WV8200DWVMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Mobile Vision, Inc Optometrist CurrentSince Apr 29, 2009 Accepting new patients
Eye and Ear Clinic Physicians, Inc Past Accepting new patients
Eye & Ear Clinic Physicians Inc Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509753600000",
    "number": "1831139419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 WOODVALE DR",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253142547",
            "telephone_number": "304-343-4371",
            "fax_number": "304-343-0215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1306 KANAWHA BLVD E",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253013001",
            "telephone_number": "304-343-4371",
            "fax_number": "304-343-0215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOWERY",
        "first_name": "MARLENE",
        "middle_name": "B",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-08",
        "last_updated": "2017-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WV",
            "license": "WV8200D",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0149311000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, WV

Sources for this page

Verify at the official NPI Registry.