Healthcare Provider Details

I. General information

NPI: 1144690769
Provider Name (Legal Business Name): WEST POINT OPTICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2015
Last Update Date: 09/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1736 W MICHIGAN AVE
JACKSON MI
49202-4005
US

IV. Provider business mailing address

3775 EASTON WAY
COLUMBUS OH
43219-6149
US

V. Phone/Fax

Practice location:
  • Phone: 517-789-7131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BILL NOBLE
Title or Position: PRESIDENT
Credential:
Phone: 614-395-9775