Healthcare Provider Details

I. General information

NPI: 1164885042
Provider Name (Legal Business Name): WEST POINT OPTICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4024 ELKHART RD SUITE 23
GOSHEN IN
46526
US

IV. Provider business mailing address

4024 ELKHART RD SUITE 23
GOSHEN IN
46526
US

V. Phone/Fax

Practice location:
  • Phone: 574-875-5042
  • Fax:
Mailing address:
  • Phone: 574-875-5042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RYAN WILLIAMS
Title or Position: VP OPERATIONS
Credential:
Phone: 904-545-4465