Basic Information
| Provider Information | |||||||||
| NPI: | 1235591355 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEST | ||||||||
| FirstName: | JUSTIN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 503 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LONDON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 407411217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068771877 | ||||||||
| FaxNumber: | 6068770082 | ||||||||
| Practice Location | |||||||||
| Address1: | 503 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LONDON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 407411217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068771877 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2016 | ||||||||
| LastUpdateDate: | 04/14/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | R4194 | KY | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 54412 | KY | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.