Provider Demographics
NPI:1245406966
Name:TAYLOR OPTICAL CO
Entity Type:Organization
Organization Name:TAYLOR OPTICAL CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:K
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:304-325-8685
Mailing Address - Street 1:332 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-4038
Mailing Address - Country:US
Mailing Address - Phone:304-325-8685
Mailing Address - Fax:304-324-0429
Practice Address - Street 1:332 NORTH ST
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-4038
Practice Address - Country:US
Practice Address - Phone:304-325-8685
Practice Address - Fax:304-324-0429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9280028000Medicaid
VA010117135Medicaid