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28 Virginia Ave, Petersburg, WV 26847-1740 | |
(304) 642-4490 | |
Not Available |
Full Name | |
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Type | Facility |
Speciality | Optometrist |
Location | 28 Virginia Ave, Petersburg, West Virginia |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1720525322 | NPI | - | NPPES |
3102000000 | Medicaid | WV |
Taxonomy | Type | License (State) | Status |
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152W00000X | Optometrist | 984-IOD (West Virginia) | Primary |
Provider Name | Cheryl L Bennett |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1245303213 PECOS PAC ID: 1759277429 Enrollment ID: I20040227000673 |
Mailing Address | Practice Location Address |
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28 Virginia Ave, Petersburg, WV 26847-1740 Ph: (681) 892-0393 | 28 Virginia Ave, Petersburg, WV 26847-1740 Ph: (304) 642-4490 |
Cheryl L Bennett, OD Optometrist Medicare: Accepting Medicare Assignments Practice Location: 28 Virginia Ave, Petersburg, WV 26847 Phone: 681-892-0393 Fax: 681-892-0299 |