| Organization Name: | EYE CENTER OF GREENBRIER VALLEY INC |
| NPI Number: | 1184775041 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PHILIP LIGHT (EXECUTIVE OFFICER) |
| Mailing Address: | 101 Davis Stuart Rd Ronceverte |
| State: | WV US |
| Postal Code: | 24970 |
| Phone Number: | 3047933937 |
| Fax Number: | 3047932203 |
| NPI Enumeration Date: | 01/16/2007 |
| NPI Last Update Date: | 05/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1100X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Ophthalmic |
| Taxonomy Definition: | |