Provider Demographics
NPI:1588735450
Name:ROMANS, JOHN PHILIP (OD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PHILIP
Last Name:ROMANS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 A HUNTINGTON MALL PO BOX 4129
Mailing Address - Street 2:
Mailing Address - City:BARBOURSFILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-4129
Mailing Address - Country:US
Mailing Address - Phone:304-736-9550
Mailing Address - Fax:304-733-0584
Practice Address - Street 1:100 A HUNTINGTON MALL
Practice Address - Street 2:
Practice Address - City:BARBOURSFILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-4129
Practice Address - Country:US
Practice Address - Phone:304-736-9550
Practice Address - Fax:304-733-0584
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV672OD152W00000X
OH5602 T2516152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV917597OtherEYEMED
WVR00598514Medicare ID - Type Unspecified
WV917597OtherEYEMED