=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881710101
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRIS ARNOLD RATCLIFF OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2007
-----------------------------------------------------
Last Update Date | 07/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 919 5TH AVE
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25701-2003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-523-4819
-----------------------------------------------------
Fax | 304-525-5551
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 919 5TH AVE
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25701-2003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-523-4819
-----------------------------------------------------
Fax | 304-525-5551
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 879OD
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------