Provider Demographics
NPI:1962528539
Name:RATCLIFF, WILLIAM LEE (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LEE
Last Name:RATCLIFF
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 1:919 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-2003
Mailing Address - Country:US
Mailing Address - Phone:304-523-4819
Mailing Address - Fax:304-525-5551
Practice Address - Street 1:919 5TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2003
Practice Address - Country:US
Practice Address - Phone:304-523-4819
Practice Address - Fax:304-525-5551
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV695OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0150623000Medicaid
WV550640354OtherTAX ID
WV550640354OtherRAILROAD MEDICARE
WV550640354OtherRAILROAD MEDICARE