| |
130 Goff Mountain Rd, Suite 12, Cross Lanes, WV 25313-1419 | |
(304) 776-5594 | |
(304) 776-3521 |
Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 130 Goff Mountain Rd, Cross Lanes, 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 |
---|---|---|---|
1700094976 | NPI | - | NPPES |
001722058 | Other | WV | BCBS PIN # |
001710665 | Other | WV | BCBS GROUP # |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 866D (West Virginia) | Primary |
Provider Name | Hilda J Maxwell |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1730215021 PECOS PAC ID: 3173437852 Enrollment ID: I20100105000001 |
Mailing Address | Practice Location Address |
---|---|
130 Goff Mountain Rd, Suite 12, Cross Lanes, WV 25313-1419 Ph: (304) 776-5594 | 130 Goff Mountain Rd, Suite 12, Cross Lanes, WV 25313-1419 Ph: (304) 776-5594 |
Dr. Michele Stanley, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 100 Nitro Market Pl, Cross Lanes, WV 25313 Phone: 304-769-2253 Fax: 304-769-2254 |