Healthcare Provider Details

I. General information

NPI: 1154028801
Provider Name (Legal Business Name): LAURA WEST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 BETHEL RD
COLUMBUS OH
43220-2217
US

IV. Provider business mailing address

2700 BETHEL RD
COLUMBUS OH
43220-2217
US

V. Phone/Fax

Practice location:
  • Phone: 614-326-0761
  • Fax:
Mailing address:
  • Phone: 614-326-0761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberOP.5644S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: