Individual
TRAVIS TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
415 D ST, SOUTH CHARLESTON, WV 25303-3107
(304) 744-1303
(304) 744-1316
Mailing address
415 D ST, PO BOX 8397, SOUTH CHARLESTON, WV 25303-3107
(304) 744-1303
(304) 744-1316
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
949IOD
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001722600
MT STATE BLUE CROSS
WV
05
—
0149981000
—
WV
01
—
5576315
AETNA
WV
Enumeration date
11/02/2005
Last updated
05/11/2016
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