Provider Demographics
NPI:1700094976
Name:MAXWELL EYECARE CENTER, INC
Entity Type:Organization
Organization Name:MAXWELL EYECARE CENTER, INC
Other - Org Name:HILDA J. MAXWELL, OD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT, OWNER, OD
Authorized Official - Prefix:DR
Authorized Official - First Name:HILDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-776-5594
Mailing Address - Street 1:130 GOFF MOUNTAIN RD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:CROSS LANES
Mailing Address - State:WV
Mailing Address - Zip Code:25313-1419
Mailing Address - Country:US
Mailing Address - Phone:304-776-5594
Mailing Address - Fax:304-776-3521
Practice Address - Street 1:130 GOFF MOUNTAIN RD
Practice Address - Street 2:SUITE 12
Practice Address - City:CROSS LANES
Practice Address - State:WV
Practice Address - Zip Code:25313-1419
Practice Address - Country:US
Practice Address - Phone:304-776-5594
Practice Address - Fax:304-776-3521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV866D152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV=========OtherTAX ID #
WV0695447Medicare ID - Type Unspecified