MEDICARE: WEST POINT OPTICAL

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

General Provider Information

NPI Number	:	1174066526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST POINT OPTICAL

Provider Business Mailing Address
First Line	:	5030 JONESTOWN RD
Second Line	:	RT22
City	:	HARRISBURG
State	:	PA
Zip	:	17112-2921
Country	:	US
Telephone Number	:	717-657-0802
Fax Number	:

Provider Business Practice Location Address
First Line	:	5030 JONESTOWN RD
Second Line	:	RT22
City	:	HARRISBURG
State	:	PA
Zip	:	17112-2921
Country	:	US
Telephone Number	:	717-657-0802
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	RYAN WILLIAMS
Credential	:
Telephone Number	:	904-545-4465

Provider Enumeration Date	:	12/02/2016
Last Update Date	:	12/02/2016

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Directions to “WEST POINT OPTICAL ” Practice Location

Language	Start Address	Practice Location

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