Provider Demographics
NPI:1346457207
Name:WYLIE, PATRICIA ESTEP (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ESTEP
Last Name:WYLIE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:ESTEP
Other - Last Name:WYLIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1589 WHEELING AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN DALE
Mailing Address - State:WV
Mailing Address - Zip Code:26038-1731
Mailing Address - Country:US
Mailing Address - Phone:304-845-2480
Mailing Address - Fax:304-845-9204
Practice Address - Street 1:1589 WHEELING AVE
Practice Address - Street 2:
Practice Address - City:GLEN DALE
Practice Address - State:WV
Practice Address - Zip Code:26038-1731
Practice Address - Country:US
Practice Address - Phone:304-845-2480
Practice Address - Fax:304-845-9204
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV675-D152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist