| |
78 Mcdowell St, Welch, WV 24801-2437 | |
(304) 436-2880 | |
Not Available |
Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 78 Mcdowell St, Welch, West Virginia |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1962578351 | NPI | - | NPPES |
287817 | Other | WV | MAMSI |
010117135 | Other | VA | VIRGINIA MEDICAID |
0150072000 | Medicaid | WV | |
0150605000 | Medicaid | WV | |
009204342 | Medicaid | VA | |
0451530 | Other | VA | ANTHEN BLUE CROSS |
9280028002 | Medicaid | WV | |
010049211 | Medicaid | VA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 689-OD (West Virginia) | Primary |
Mailing Address | Practice Location Address |
---|---|
410 Fincastle Ln, Bluefield, VA 24605-9243 Ph: (276) 326-3762 | 78 Mcdowell St, Welch, WV 24801-2437 Ph: (304) 436-2880 |