Provider Demographics
NPI:1932183175
Name:TAYLOR, DONALD RAYMOND (OD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:RAYMOND
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 LUMBER AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5390
Mailing Address - Country:US
Mailing Address - Phone:304-242-5544
Mailing Address - Fax:304-242-2560
Practice Address - Street 1:2106 LUMBER AVE
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5390
Practice Address - Country:US
Practice Address - Phone:304-242-5544
Practice Address - Fax:304-242-2560
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2008-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV594OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0149809000Medicaid
WV0456970001Medicare NSC
WV0149809000Medicaid