Provider Demographics
NPI:1356382675
Name:CAUDILL, JAMES WHITE (MD RETIRED)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:WHITE
Last Name:CAUDILL
Suffix:
Gender:M
Credentials:MD RETIRED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 SUMMERS ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1239
Mailing Address - Country:US
Mailing Address - Phone:304-343-3937
Mailing Address - Fax:304-344-3957
Practice Address - Street 1:501 SUMMERS ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1239
Practice Address - Country:US
Practice Address - Phone:304-343-3937
Practice Address - Fax:304-344-3957
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12658207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1505896OtherCIGNA
WV1356382675OtherHEALTHNET TRICARE
WV4242529OtherAETNA
WVA727OtherWEST VIRGINIA EYE CONSULTANTS -GROUP MEDICARE NUMBER
WV1356382675OtherHUMANA
WV1356382675OtherSTRATOSE
WV1356382675OtherHEALTHSMART PEIA
WV679245OtherCOVENTRY
WV09152012OtherHIGHMARK BCBS
WV3810021966OtherGROUP MEDICAID
WVA727OtherWEST VIRGINIA EYE CONSULTANTS -GROUP MEDICARE NUMBER
WV09152012OtherHIGHMARK BCBS
WV1356382675OtherHEALTHSMART PEIA