Provider Demographics
NPI:1477659159
Name:ROSS, PATRICIA NEAL (OD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:NEAL
Last Name:ROSS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV772-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
001720786OtherBC/BS
WV0150824000Medicaid
555319OtherNVA
0222970001OtherADMINISTAR
53311OtherDAVIS
29701OtherSPECTERA
T89958Medicare UPIN