Elizabeth Noel Distefano, OD
Individual provider Active NPI Optometrist · Wayne, WV
NPI 1639458276 · NPPES record last updated May 28, 2024
Key facts
- NPI
- 1639458276
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 2045-IOD (WV)
- Practice address
- 42 McGinnis Dr
Wayne, WV 25570-9553 - Phone
- (304) 272-5136
- Fax
- (304) 272-6261
- NPI assigned
- Aug 14, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 7
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Indiana University - School of Optometry, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Valley Health Systems, Inc
Practice addresses (Care Compare)
1 Harbour Way
Milton, WV 25541-1545
Phone (304) 781-3600
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180718004096 | WV | Practitioner - Optometry | 3072860261 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0618002273 | VA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Valley Health Systems, Inc. | Current |
Accepting new patients | |
| Valley Health Systems Inc | Current | Accepting new patients | |
| Valley Health Systems, Inc | Current |
Accepting new patients | |
| Valley Health Systems, Inc. | Optometrist | Current |
Accepting new patients |
| Valley Health Systems Inc | Optometrist | Current |
Accepting new patients |
| America'S Best Contacts & Eyeglasses | Past | Accepting new patients | |
| Valley Health Systems Inc | Past | Accepting new patients |
Locations
85 Donohoe Dr
Huntington, WV 25705
Phone (304) 399-3310
2585 3rd Ave
Huntington, WV 25703
Phone (304) 697-1396
1 Harbour Way
Milton, WV 25541
Phone (304) 743-1407
42 McGinnis Dr
Wayne, WV 25570
Phone (304) 272-5136
Interoperability endpoints
- edistefano20046@valleyhealthsystems.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 0618002273 | VA | |
| Optometrist | 152W00000X | 2045-IOD | WV | Yes |
Addresses
Primary practice location
42 McGinnis Dr
Wayne, WV 25570-9553
Mailing address
2585 3Rd Ave
Huntington, WV 25703-1642
Phone (304) 697-1396
Other practice location 1
145 Holt Garrison Pkwy
Danville, VA 24540-5958
Phone (434) 483-2199
Other practice location 2
85 Donohoe Dr
Huntington, WV 25705-8887
Phone (304) 399-3310
Other names
- Elizabeth Noel Randolph
Other providers in Wayne, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 28, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.