MEDICARE: DR. WILLIAM ALAN RADA O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	774-OD	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001720471	OTHER	WV	BLUE CROSS BLUE SHIELD
2	4320198	OTHER	WV	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	0621280001	OTHER	WV	ADMINISTAR

General Provider Information

NPI Number	:	1790885655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM ALAN RADA O.D.

Provider Business Mailing Address
First Line	:	4202 MACCORKLE AVE SE
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25304-2502
Country	:	US
Telephone Number	:	304-925-4761
Fax Number	:

Provider Business Practice Location Address
First Line	:	4202 MACCORKLE AVE SE
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25304-2502
Country	:	US
Telephone Number	:	304-925-4761
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	11/10/2014

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