Healthcare Provider Details

I. General information

NPI: 1114062999
Provider Name (Legal Business Name): SEAN WEST OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 MAIN ST
STRATFORD CT
06615-7406
US

IV. Provider business mailing address

775 MAIN ST
STRATFORD CT
06615-7406
US

V. Phone/Fax

Practice location:
  • Phone: 203-377-2020
  • Fax: 203-381-9936
Mailing address:
  • Phone: 203-377-2020
  • Fax: 203-381-9936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11978T
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number002824
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: