MEDICARE: JODIE L WEST O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	6054TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7774588	OTHER	TX	AETNA
2	800117058	OTHER	TX	UNITED HELATH CARE
3	80-0117058	OTHER	TX	LIFE RE
4	81163Q	OTHER	TX	BLUE CROSS BLUE SHIELD
5	625436	OTHER	TX	CIGNA
6	454320	OTHER	TX	NVA
7	19700	OTHER	TX	AVESIS
8	914046	OTHER	TX	EYEMED
9	80-0117058	OTHER	TX	SUPERIOR

General Provider Information

NPI Number	:	1083713127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODIE L WEST O.D.

Provider Business Mailing Address
First Line	:	800 CRYSTAL FALLS PKWY
Second Line	:	#4
City	:	LEANDER
State	:	TX
Zip	:	78641-3666
Country	:	US
Telephone Number	:	512-260-0405
Fax Number	:	512-260-0425

Provider Business Practice Location Address
First Line	:	800 CRYSTAL FALLS PKWY
Second Line	:	#4
City	:	LEANDER
State	:	TX
Zip	:	78641-3666
Country	:	US
Telephone Number	:	512-260-0405
Fax Number	:	512-260-0425

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	08/19/2008

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Directions to “ JODIE L WEST O.D.” Practice Location

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