Provider Demographics
NPI:1124234836
Name:TO HEALTHY EYES
Entity type:Organization
Organization Name:TO HEALTHY EYES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-744-9533
Mailing Address - Street 1:4008 MACCORKLE AVE SW
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1510
Mailing Address - Country:US
Mailing Address - Phone:304-744-9533
Mailing Address - Fax:304-744-2387
Practice Address - Street 1:4008 MACCORKLE AVE SW
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1510
Practice Address - Country:US
Practice Address - Phone:304-744-9533
Practice Address - Fax:304-744-2387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV0690-OD332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier