Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | OPC 4183 | FL |
Y | 152W00000X | Optometrist | S-894-TA-474 | AL |
NPI | 1003985201 |
---|---|
Provider Name | Eric P West |
First Address | Mobile, AL 36695-3926 |
Second Address | Mobile, AL 36695-3926 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 01/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V01954 | (02) | AL |