MEDICARE: DR. DOUGLAS BRIAN WEST O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	18002092	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295774719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS BRIAN WEST O.D.

Provider Business Mailing Address
First Line	:	1545 FORT HARRISON RD
Second Line	:
City	:	TERRE HAUTE
State	:	IN
Zip	:	47804-1332
Country	:	US
Telephone Number	:	812-460-0520
Fax Number	:	812-460-0407

Provider Business Practice Location Address
First Line	:	1545 FORT HARRISON RD
Second Line	:
City	:	TERRE HAUTE
State	:	IN
Zip	:	47804-1332
Country	:	US
Telephone Number	:	812-460-0520
Fax Number	:	812-460-0407

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	06/04/2010

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