Provider Demographics
NPI:1508895475
Name:TAYLOR EYE ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:TAYLOR EYE ASSOCIATES, PLLC
Other - Org Name:SOUTH CHARLESTON EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-744-1303
Mailing Address - Street 1:PO BOX 8397
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303-0397
Mailing Address - Country:US
Mailing Address - Phone:304-744-1303
Mailing Address - Fax:304-744-1316
Practice Address - Street 1:415 D ST
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-3107
Practice Address - Country:US
Practice Address - Phone:304-744-1303
Practice Address - Fax:304-744-1316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0205140000Medicaid
WV4432280001Medicare NSC
WV9311322Medicare ID - Type UnspecifiedGROUP MEDICARE
WV9311322Medicare PIN