MEDICARE: WILLIAM ALAN RADA, OD

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	774OD	WV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410004799	OTHER	WV	RAIL ROAD MEDICARE

General Provider Information

NPI Number	:	1841485687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM ALAN RADA, OD

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	:	304-925-0310

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	:	304-925-0310

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WILLIAM ALAN RADA
Credential	:	O.D.
Telephone Number	:	304-925-4761

Provider Enumeration Date	:	09/13/2007
Last Update Date	:	12/03/2010

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