MEDICARE: JERE MICAH WEST LDO

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	156FX1800X	Optician	DO8439	FL

General Provider Information

NPI Number	:	1689507329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERE MICAH WEST LDO

Provider Business Mailing Address
First Line	:	1621 MAIN ST
Second Line	:
City	:	CHIPLEY
State	:	FL
Zip	:	32428-5992
Country	:	US
Telephone Number	:	850-638-3214
Fax Number	:	850-638-7797

Provider Business Practice Location Address
First Line	:	1621 MAIN ST
Second Line	:
City	:	CHIPLEY
State	:	FL
Zip	:	32428-5992
Country	:	US
Telephone Number	:	850-638-3214
Fax Number	:	850-638-7797

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

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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Directions to “ JERE MICAH WEST LDO” Practice Location

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