Provider Demographics
NPI:1477708972
Name:TAYLOR EYE ASSOCIATES PLLC
Entity type:Organization
Organization Name:TAYLOR EYE ASSOCIATES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:1901 19TH ST
Mailing Address - Street 2:PO BOX 474
Mailing Address - City:NITRO
Mailing Address - State:WV
Mailing Address - Zip Code:25143-1751
Mailing Address - Country:US
Mailing Address - Phone:304-755-4341
Mailing Address - Fax:
Practice Address - Street 1:1901 19TH ST
Practice Address - Street 2:
Practice Address - City:NITRO
Practice Address - State:WV
Practice Address - Zip Code:25143-1751
Practice Address - Country:US
Practice Address - Phone:304-755-4341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4432280002Medicare NSC