Provider Demographics
NPI:1730215021
Name:MAXWELL, HILDA J (OD)
Entity type:Individual
Prefix:DR
First Name:HILDA
Middle Name:J
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5098 WASHINGTON ST W STE 408
Mailing Address - Street 2:
Mailing Address - City:CROSS LANES
Mailing Address - State:WV
Mailing Address - Zip Code:25313-1561
Mailing Address - Country:US
Mailing Address - Phone:304-776-5594
Mailing Address - Fax:304-776-3521
Practice Address - Street 1:167 PROGRESS WAY
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-7450
Practice Address - Country:US
Practice Address - Phone:304-562-3200
Practice Address - Fax:304-562-3201
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV866 D152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV550753899OtherTAX ID
WV3810028317Medicaid
WV001710665OtherBLUE CROSS BLUE SHIELD