=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952092595
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WESTIN GEORGE COHEN OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2023
-----------------------------------------------------
Last Update Date | 12/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 287 SCHOOL ST
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02048-1850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-339-6800
-----------------------------------------------------
Fax | 508-339-6700
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 CARRIAGE HOUSE DR
-----------------------------------------------------
City | LAKEVILLE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02347-1358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-218-5001
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | ODTG00739
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPT5613
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------