Provider Demographics
NPI:1174620231
Name:BLUEFIELD COMMUNITY EYE CLINIC PLLC
Entity type:Organization
Organization Name:BLUEFIELD COMMUNITY EYE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YASIER
Authorized Official - Middle Name:
Authorized Official - Last Name:KANAWATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-325-5711
Mailing Address - Street 1:510 CHERRY ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-3338
Mailing Address - Country:US
Mailing Address - Phone:304-325-5711
Mailing Address - Fax:304-327-1789
Practice Address - Street 1:510 CHERRY ST
Practice Address - Street 2:SUITE 305
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-3338
Practice Address - Country:US
Practice Address - Phone:304-325-5711
Practice Address - Fax:304-327-1789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty