Basic Information
| Provider Information | |||||||||
| NPI: | 1922610302 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST POINT OPTICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10706 E POINT TWENTY-TWO BLVD | ||||||||
| Address2: | #107 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9045454465 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10706 E POINT TWENTY-TWO BLVD | ||||||||
| Address2: | #107 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9045454465 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2020 | ||||||||
| LastUpdateDate: | 08/18/2020 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 9045454465 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.