Healthcare Provider Details

I. General information

NPI: 1174066526
Provider Name (Legal Business Name): WEST POINT OPTICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2016
Last Update Date: 12/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 JONESTOWN RD RT22
HARRISBURG PA
17112-2921
US

IV. Provider business mailing address

5030 JONESTOWN RD RT22
HARRISBURG PA
17112-2921
US

V. Phone/Fax

Practice location:
  • Phone: 717-657-0802
  • Fax:
Mailing address:
  • Phone: 717-657-0802
  • 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
Credential:
Phone: 904-545-4465