Provider Demographics
NPI:1699737759
Name:BAILEY, STEVEN GLENN (OD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:GLENN
Last Name:BAILEY
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 1:6010 ROUTE 60 EAST
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504
Mailing Address - Country:US
Mailing Address - Phone:304-733-0809
Mailing Address - Fax:304-733-4234
Practice Address - Street 1:6010 ROUTE 60 EAST
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504
Practice Address - Country:US
Practice Address - Phone:304-733-0809
Practice Address - Fax:304-733-4234
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV717-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0150705000Medicaid
WV0150705000Medicaid
WVT65165Medicare UPIN