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General NPI Number Information
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NPI Number | 1689743874
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Entity Type | Individual
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Provider Name | TIFFANY SHORT WEST O.D.
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Gender | Female
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 03/01/2021
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Provider Practice Location Address
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Address Line | 1432 HILLCREST RD
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City | MOBILE
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State | AL
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Zip | 36695-3926
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Country | US
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Telephone | 251-301-7620
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Fax | 251-219-7835
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Provider Business Mailing Address
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Address Line | 1432 HILLCREST RD
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City | MOBILE
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State | AL
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Zip | 36695-3926
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Country | US
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Telephone | 251-301-7620
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Fax | 251-219-7835
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 3962-OC3698
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT001985
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | S-890-TA-469
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License Number State | AL
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