Individual
DALE BLAKE LILLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2823 3RD AVE, HUNTINGTON, WV 25702-1423
(304) 523-3937
(304) 523-3945
Mailing address
2823 3RD AVE, HUNTINGTON, WV 25702-1423
(304) 523-3937
(304) 523-3945
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
17041
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0096101000
—
WV
05
—
0219534
—
OH
01
—
17041
WV STATE
WV
Enumeration date
07/28/2006
Last updated
04/04/2013
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