1619044963 NPI number — DR. DONALD K TAYLOR

Table of content: (NPI 1619044963)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619044963 NPI number — DR. DONALD K TAYLOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. DONALD K TAYLOR
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TAYLOR OPTICAL CO.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619044963
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
410 FINCASTLE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLUEFIELD
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24605-9243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-425-3679
Provider Business Mailing Address Fax Number:
304-425-7265

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
868 MERCER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24740-2908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-425-3679
Provider Business Practice Location Address Fax Number:
304-425-7265
Provider Enumeration Date:
11/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ALIFF
Authorized Official First Name:
JEAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFFICE MANAGER
Authorized Official Telephone Number:
304-325-8685

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  689-OD , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010117135 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0150605000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9280028001 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0150072000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001719832 . This is a "BLUE CROSS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 009204342 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 287817 . This is a "MAMSI" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0451528 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0100049211 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1055543 . This is a "BRICKSTREET" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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