Provider Demographics
NPI:1174637128
Name:RAAB, LAURIE A (OD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:A
Last Name:RAAB
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 THREE SPRINGS DR STE 14
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-3866
Mailing Address - Country:US
Mailing Address - Phone:304-748-2055
Mailing Address - Fax:304-748-2054
Practice Address - Street 1:241 THREE SPRINGS DR STE 14
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-3866
Practice Address - Country:US
Practice Address - Phone:304-748-2055
Practice Address - Fax:304-748-2054
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV706-OD152W00000X
PAOEG001174152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810006166Medicaid
WV0570540001Medicare NSC
WV0809624Medicare PIN
WVU28598Medicare UPIN
PA447647Medicare PIN
PA0570540002Medicare NSC
WV0570540003Medicare NSC
WV3810006166Medicaid