Provider Demographics
NPI:1740469386
Name:BOSLEY EYE CARE, INC.
Entity type:Organization
Organization Name:BOSLEY EYE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:BOSLEY
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:304-538-5930
Mailing Address - Street 1:8 LEE ST
Mailing Address - Street 2:SUITE 134
Mailing Address - City:MOOREFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:26836-1091
Mailing Address - Country:US
Mailing Address - Phone:304-538-5930
Mailing Address - Fax:304-538-5931
Practice Address - Street 1:8 LEE ST
Practice Address - Street 2:SUITE 134
Practice Address - City:MOOREFIELD
Practice Address - State:WV
Practice Address - Zip Code:26836-1091
Practice Address - Country:US
Practice Address - Phone:304-538-5930
Practice Address - Fax:304-538-5931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1023261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810003979Medicaid
WV5550280001Medicare NSC