NPIMap

Organization Active NPI

Eye Doc Inc

  • Optometrist
  • Nitro, WV
National Provider Identifier
1962455261
Registry record updated Oct 31, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
WV859OD Issued in WV
Legal business name
EYE DOC INC
Practice address
100 Nitro Marketplace
Nitro, WV 25143
Phone
(304) 769-2253
Fax
(304) 769-2254
NPI assigned
May 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2012

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

Authorized official

Name
Dr. Louis J Stanley, ODNPI 1053526855
Title
President
Phone
(304) 344-0162

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 WV859OD WV Primary

Addresses

Primary practice location

100 Nitro Marketplace
Nitro, WV 25143

Mailing address

1542 Thomas Cir
Charleston, WV 25314-1623
Phone (304) 344-0162

Other identifiers 1

IdentifierTypeStateIssuer
EY9289823OtherWVMEDICARE GROUP NUMBER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050727001132 WV Part B Supplier - Clinic/Group Practice 1153359583 Receives reassigned benefits from 1 practitioner
Practice locations: Cross Lanes, WV

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351641600000",
    "number": "1962455261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1542 THOMAS CIR",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253141623",
            "telephone_number": "304-344-0162",
            "fax_number": "304-769-2254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 NITRO MARKETPLACE",
            "city": "NITRO",
            "state": "WV",
            "postal_code": "25143",
            "telephone_number": "304-769-2253",
            "fax_number": "304-769-2254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE DOC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2012-10-31",
        "status": "A",
        "authorized_official_last_name": "STANLEY",
        "authorized_official_first_name": "LOUIS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "304-344-0162",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WV",
            "license": "WV859OD",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "EY9289823",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nitro, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2012; 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.