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General NPI Number Information
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NPI Number | 1477638849
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Entity Type | Organization
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Legal Business Name | W WAYNE WEST OD PC
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 04/10/2008
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Provider Practice Location Address
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Address Line | 545 COMMERCE STREET
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City | HAWKINSVILLE
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State | GA
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Zip | 31036-1139
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Country | US
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Telephone | 478-783-4186
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Fax | 478-783-4185
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Provider Business Mailing Address
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Address Line | PO BOX 446
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City | HAWKINSVILLE
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State | GA
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Zip | 31036-0446
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Country | US
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Telephone | 478-783-4186
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Fax | 478-783-4185
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. BETTY GOODSON WEST
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Credential |
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Telephone | 478-783-4186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0PT000682
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License Number State | GA
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