Individual
MATTHEW ROSSLAND INGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
418 GRAND PARK DR, SUITE 315, PARKERSBURG, WV 26105-4000
(304) 428-3500
(304) 422-7900
Mailing address
418 GRAND PARK DR, SUITE 315, PARKERSBURG, WV 26105-4000
(304) 428-3500
(304) 422-7900
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T2470
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000384708
ANTHEM BLUE CROSS
—
01
—
001772033
MOUNTAIN STATE BLUE CROSS
WV
01
—
0707695
CIGNA
—
05
—
2590414
—
OH
05
—
3810003387
—
WV
01
—
7395753
AETNA
—
01
—
P00269537
RAILROAD MEDICARE
—
Enumeration date
06/22/2006
Last updated
08/03/2007
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