Basic Information
| Provider Information | |||||||||
| NPI: | 1942353891 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DR. KRESS EYECARE ASSOCIATES, PLLC | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 920 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BRIDGEPORT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 263301651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3048424444 | ||||||||
| FaxNumber: | 3048424491 | ||||||||
| Practice Location | |||||||||
| Address1: | 920 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BRIDGEPORT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 263301651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3048424444 | ||||||||
| FaxNumber: | 3048424491 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2007 | ||||||||
| LastUpdateDate: | 02/18/2015 | ||||||||
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| AuthorizedOfficialLastName: | KRESS | ||||||||
| AuthorizedOfficialFirstName: | THEODORE | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3048424444 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 4000412000 | 05 | WV | MEDICAID | 001994596 | 01 | WV | BCBS | OTHER | 1314480002 | 01 | WV | CIGNA GOVERNMENT SERVICES | OTHER | 1314480002 | 01 | WV | DMERC | OTHER | 1942353891 | 01 | WV | NPI | OTHER | CG7036 | 01 | WV | RAILROAD | OTHER |