Provider Demographics
NPI:1619044963
Name:DR. DONALD K TAYLOR
Entity Type:Organization
Organization Name:DR. DONALD K TAYLOR
Other - Org Name:TAYLOR OPTICAL CO.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-325-8685
Mailing Address - Street 1:410 FINCASTLE LN
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24605-9243
Mailing Address - Country:US
Mailing Address - Phone:304-425-3679
Mailing Address - Fax:304-425-7265
Practice Address - Street 1:868 MERCER ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2908
Practice Address - Country:US
Practice Address - Phone:304-425-3679
Practice Address - Fax:304-425-7265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV689-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010117135Medicaid
WV0150605000Medicaid
WV9280028001Medicaid
WV0150072000Medicaid
WV001719832OtherBLUE CROSS
VA009204342Medicaid
WV287817OtherMAMSI
VA0451528OtherANTHEM BLUE CROSS
VA0100049211Medicaid
WV1055543OtherBRICKSTREET