Provider Demographics
NPI:1770516320
Name:BOSLEY, WILLIAM GERALD III (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GERALD
Last Name:BOSLEY
Suffix:III
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV1023152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810003727Medicaid
WVU71409Medicare UPIN
WVB04169911Medicare ID - Type Unspecified