1083733893 NPI number — JODIE L. WEST, O.D., P.A

Table of content: (NPI 1083733893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083733893 NPI number — JODIE L. WEST, O.D., P.A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JODIE L. WEST, O.D., P.A
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083733893
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 CRYSTAL FALLS PKWY
Provider Second Line Business Mailing Address:
#4
Provider Business Mailing Address City Name:
LEANDER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78641-3666
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-260-0405
Provider Business Mailing Address Fax Number:
512-260-0425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 CRYSTAL FALLS PKWY
Provider Second Line Business Practice Location Address:
#4
Provider Business Practice Location Address City Name:
LEANDER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78641-3666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-260-0405
Provider Business Practice Location Address Fax Number:
512-260-0425
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WEST
Authorized Official First Name:
JODIE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT, OPTOMETRIST
Authorized Official Telephone Number:
512-260-0405

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  6054TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AETNA . This is a "7774588" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: CIGNA . This is a "625436001" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: EYEMED VISION CARE . This is a "914046" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: NVA . This is a "454320" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: LIFE RE , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: CLARITY VISION . This is a "1463587" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: BCBS . This is a "81163Q" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: GREAT WEST , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: UNITED HEALTH CARE , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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