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General NPI Number Information
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NPI Number | 1700094976
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Entity Type | Organization
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Legal Business Name | MAXWELL EYECARE CENTER, INC
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Dates
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Enumeration Date | 05/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 130 GOFF MOUNTAIN RD SUITE 12
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City | CROSS LANES
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State | WV
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Zip | 25313-1419
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Country | US
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Telephone | 304-776-5594
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Fax | 304-776-3521
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Provider Business Mailing Address
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Address Line | 130 GOFF MOUNTAIN RD SUITE 12
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City | CROSS LANES
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State | WV
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Zip | 25313-1419
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Country | US
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Telephone | 304-776-5594
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Fax | 304-776-3521
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Authorized Official
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Title or Position | PRESIDENT, OWNER, OD
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Name | DR. HILDA J MAXWELL
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Credential | OD
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Telephone | 304-776-5594
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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 | 866D
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License Number State | WV
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