Basic Information
| Provider Information | |||||||||
| NPI: | 1932568003 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST POINT OPTICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4024 ELKHART RD | ||||||||
| Address2: | SUITE 23 | ||||||||
| City: | GOSHEN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465265807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9045454465 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5418 N SHORE PL | ||||||||
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| City: | MASON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450405023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143959775 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2016 | ||||||||
| LastUpdateDate: | 02/18/2016 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | RYAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 9045454465 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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.