Healthcare Provider Details

I. General information

NPI: 1184282816
Provider Name (Legal Business Name): NATALIE NICHOLE WEST OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 UNIVERSITY BLVD
BIRMINGHAM AL
35233-1816
US

IV. Provider business mailing address

1716 UNIVERSITY BLVD HPB G080A
BIRMINGHAM AL
35294-0010
US

V. Phone/Fax

Practice location:
  • Phone: 205-975-2020
  • Fax: 205-934-6755
Mailing address:
  • Phone: 205-975-2020
  • Fax: 205-934-6755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS-E38-TA-B45
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: