Healthcare Provider Details

I. General information

NPI: 1215466206
Provider Name (Legal Business Name): WEST POINT OPTICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4413 TOWN CENTER PKWY STE 207
JACKSONVILLE FL
32246-8570
US

IV. Provider business mailing address

4413 TOWN CENTER PKWY STE 207
JACKSONVILLE FL
32246-8570
US

V. Phone/Fax

Practice location:
  • Phone: 904-998-9871
  • Fax:
Mailing address:
  • Phone: 904-998-9871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM WILLIAMS
Title or Position: COO
Credential:
Phone: 904-545-4465