MEDICARE: JAMES BURTON WESTFALL 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	TUV002995-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000915122001	OTHER	NY	HEALTH NOW NYS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	7701142	OTHER	NY	MVP
4	100094CS	OTHER	NY	PREFERRED CARE
5	0069431	OTHER	NY	GHI NY

General Provider Information

NPI Number	:	1396794673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES BURTON WESTFALL O.D.

Provider Business Mailing Address
First Line	:	1210 DRIVING PARK AVE
Second Line	:
City	:	NEWARK
State	:	NY
Zip	:	14513-1057
Country	:	US
Telephone Number	:	315-331-8921
Fax Number	:	315-331-8231

Provider Business Practice Location Address
First Line	:	1210 DRIVING PARK AVE
Second Line	:
City	:	NEWARK
State	:	NY
Zip	:	14513-1057
Country	:	US
Telephone Number	:	315-331-8921
Fax Number	:	315-331-8231

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

Provider Enumeration Date	:	05/06/2006
Last Update Date	:	07/08/2007

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