Healthcare Provider Details

I. General information

NPI: 1750795498
Provider Name (Legal Business Name): WEST POINT OPTICAL EASTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 06/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3948 MORSE XING
COLUMBUS OH
43219-6081
US

IV. Provider business mailing address

3948 MORSE XING
COLUMBUS OH
43219-6081
US

V. Phone/Fax

Practice location:
  • Phone: 614-475-6512
  • Fax:
Mailing address:
  • Phone: 614-475-6512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: KELLY REINHART
Title or Position: STORE GENERAL MANAGER
Credential:
Phone: 614-475-6512