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General NPI Number Information
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NPI Number | 1154370492
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Entity Type | Individual
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Provider Name | MALINDA LUCKY FLORES O.D.
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Gender | Female
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 04/14/2008
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Provider Practice Location Address
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Address Line | 809 MINERAL RD
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City | GLENVILLE
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State | WV
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Zip | 26351-1385
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Country | US
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Telephone | 304-462-8314
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Fax |
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Provider Business Mailing Address
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Address Line | 37 ALEXANDER DR
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City | WILLIAMSTOWN
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State | WV
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Zip | 26187-8302
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Country | US
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Telephone | 304-375-4748
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 951-OD
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License Number State | WV
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