Healthcare Provider Details

I. General information

NPI: 1851730451
Provider Name (Legal Business Name): DR WES WHEADON OPTOMETRIST, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 12/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8240 SANTA MONICA BLVD
WEST HOLLYWOOD CA
90046-5916
US

IV. Provider business mailing address

8240 SANTA MONICA BLVD
WEST HOLLYWOOD CA
90046-5916
US

V. Phone/Fax

Practice location:
  • Phone: 323-654-5600
  • Fax: 323-654-5614
Mailing address:
  • Phone: 323-654-5600
  • Fax: 323-654-5614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number0005481TLG
License Number StateCA

VIII. Authorized Official

Name: DR. DONALD W. WHEADON
Title or Position: PRESIDENT
Credential: OD
Phone: 323-654-5600