Individual
MR. JERRY DEAN WEST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
7171 S YALE AVE, STE 104, TULSA, OK 74136-6367
(918) 492-1722
(918) 492-3578
Mailing address
7171 S YALE AVE, STE 104, TULSA, OK 74136-6367
(918) 492-1722
(918) 492-3578
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0853
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100764250A
—
OK
01
—
4486602
AETNA
—
Enumeration date
06/22/2005
Last updated
06/16/2010
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