Provider Demographics
NPI:1730265562
Name:COMPLETE EYE CARE PLLC
Entity type:Organization
Organization Name:COMPLETE EYE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KNOTTS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-265-1851
Mailing Address - Street 1:216 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WV
Mailing Address - Zip Code:26354-1442
Mailing Address - Country:US
Mailing Address - Phone:304-265-1851
Mailing Address - Fax:304-265-0028
Practice Address - Street 1:216 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WV
Practice Address - Zip Code:26354-1442
Practice Address - Country:US
Practice Address - Phone:304-265-1851
Practice Address - Fax:304-265-0028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV998OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3102041000Medicaid
WVU88109OtherDR UPIN
WV9329581Medicare PIN
WVU88109OtherDR UPIN