Healthcare Provider Details

I. General information

NPI: 1154354702
Provider Name (Legal Business Name): EMILY MCNEELY BOSLEY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 LEE ST SUITE 134
MOOREFIELD WV
26836-1091
US

IV. Provider business mailing address

8 LEE ST SUITE 134
MOOREFIELD WV
26836-1091
US

V. Phone/Fax

Practice location:
  • Phone: 304-538-5930
  • Fax: 304-538-5931
Mailing address:
  • Phone: 304-538-5930
  • Fax: 304-538-5931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1022
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: