Organization
W WAYNE WEST OD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BETTY GOODSON WEST (OFFICE MANAGER)
(478) 783-4186
Entity
Organization
Contact information
Practice address
545 COMMERCE STREET, HAWKINSVILLE, GA 31036-1139
(478) 783-4186
(478) 783-4185
Mailing address
PO BOX 446, HAWKINSVILLE, GA 31036-0446
(478) 783-4186
(478) 783-4185
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0PT000682
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000004936A4
—
GA
01
—
100752
AVESIS
GA
Enumeration date
10/26/2006
Last updated
04/10/2008
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