Charleston Vision Source

LBN: Moderneyes, Pllc
Charleston Vision Source is an health care organization with primary practice located at 4202 Maccorkle Ave Se , Charleston WV 25304-2502. The organization recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as the primary health care specialty. Moderneyes, Pllc can be contacted via phone (304) 925-4761, or through Suppa Sammons, Laura M via phone (304) 545-8366.

Contact Information

Primary practice address
4202 Maccorkle Ave Se Charleston WV 25304-2502
Phone: (304) 925-4761
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Suppa Sammons, Laura M Doctor of Optometry (OD)
Phone: (304) 545-8366

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X

Profile Details

NPI number 1649933763
LBN Legal business name Moderneyes, Pllc
DBA Doing business as Charleston Vision Source
Authorized official Suppa Sammons, Laura M Doctor of Optometry (OD)
Entity Organization
Organization subpart 1 Yes
Enumeration date Oct 15th, 2021
Last updated May 25th, 2023 - about 2 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649933763 NPPES
West Virginia MEDICAID 3910005909

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