Provider Demographics
NPI:1053499467
Name:ROBERT L & CHERYL R JOSEPH DBA PROFESSIONAL OPTICAL CENTER
Entity type:Organization
Organization Name:ROBERT L & CHERYL R JOSEPH DBA PROFESSIONAL OPTICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-232-8440
Mailing Address - Street 1:1300 MARKET STREET
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:304-232-6911
Mailing Address - Fax:304-232-6928
Practice Address - Street 1:1300 MARKET ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-232-6911
Practice Address - Fax:304-232-6911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV9134332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0450631Medicaid
WV0095927000OtherMEDICADE
OH0450631Medicaid
WV0401881Medicare PIN
WV0095927000OtherMEDICADE
WVC34946Medicare UPIN