Healthcare Provider Details

I. General information

NPI: 1134319122
Provider Name (Legal Business Name): DONA DANIELLE WRATCHFORD O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 11/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 HAMPTON CTR SUITE A
MORGANTOWN WV
26505-1708
US

IV. Provider business mailing address

3000 HAMPTON CTR SUITE A
MORGANTOWN WV
26505-1708
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-2020
  • Fax: 304-598-2024
Mailing address:
  • Phone: 304-598-2020
  • Fax: 304-598-2024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2546
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1084-OD
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: