Provider Demographics
NPI:1154370492
Name:FLORES, MALINDA LUCKY (OD)
Entity type:Individual
Prefix:DR
First Name:MALINDA
Middle Name:LUCKY
Last Name:FLORES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 ALEXANDER DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26187-8302
Mailing Address - Country:US
Mailing Address - Phone:304-375-4748
Mailing Address - Fax:
Practice Address - Street 1:809 MINERAL RD
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:WV
Practice Address - Zip Code:26351-1385
Practice Address - Country:US
Practice Address - Phone:304-462-8314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV951-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0150059001Medicaid
WV410044882OtherRAILROAD MEDICARE
WV001721029OtherBCBS
WVLU4042441Medicare PIN
WV410044882OtherRAILROAD MEDICARE
WV0150059001Medicaid
WVLU4042442Medicare PIN
WVFL4225951Medicare PIN