Provider Demographics
NPI:1962578351
Name:DR. DONALD K TAYLOR
Entity type:Organization
Organization Name:DR. DONALD K TAYLOR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-325-8685
Mailing Address - Street 1:410 FINCASTLE LN
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24605-9243
Mailing Address - Country:US
Mailing Address - Phone:276-326-3762
Mailing Address - Fax:
Practice Address - Street 1:78 MCDOWELL ST
Practice Address - Street 2:
Practice Address - City:WELCH
Practice Address - State:WV
Practice Address - Zip Code:24801-2437
Practice Address - Country:US
Practice Address - Phone:304-436-2880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV689-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV287817OtherMAMSI
VA010117135OtherVIRGINIA MEDICAID
WV0150072000Medicaid
WV0150605000Medicaid
VA009204342Medicaid
VA0451530OtherANTHEN BLUE CROSS
WV9280028002Medicaid
VA010049211Medicaid