Provider Demographics
NPI:1679535777
Name:AUDIA, JOSEPH (OD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:AUDIA
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 1:2403 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:WV
Mailing Address - Zip Code:26426-7523
Mailing Address - Country:US
Mailing Address - Phone:304-782-1005
Mailing Address - Fax:
Practice Address - Street 1:2403 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:WV
Practice Address - Zip Code:26426-7523
Practice Address - Country:US
Practice Address - Phone:304-782-1005
Practice Address - Fax:304-782-3303
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2020-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0781-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0150813000Medicaid
WV0128910001Medicare NSC
WVT32359Medicare UPIN
WV0535583Medicare PIN
WV0128910002Medicare NSC