Provider Demographics
NPI:1710321237
Name:PATRICIA NEAL ROSS OD OC
Entity Type:Organization
Organization Name:PATRICIA NEAL ROSS OD OC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-294-7465
Mailing Address - Street 1:HC 89 BOX 421
Mailing Address - Street 2:
Mailing Address - City:MC GRAWS
Mailing Address - State:WV
Mailing Address - Zip Code:25876-9705
Mailing Address - Country:US
Mailing Address - Phone:304-294-7465
Mailing Address - Fax:
Practice Address - Street 1:HC 89 BOX 421
Practice Address - Street 2:
Practice Address - City:MC GRAWS
Practice Address - State:WV
Practice Address - Zip Code:25876-9705
Practice Address - Country:US
Practice Address - Phone:304-294-7465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV772OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
53311OtherDAVIS
WV0150824000Medicaid
555319OtherNVA
29701OtherSPECTERA
0222970001OtherADMINISTAR
53311OtherDAVIS