Provider Demographics
NPI:1679987416
Name:WEST POINT OPTICAL CENTERVILLE
Entity type:Organization
Organization Name:WEST POINT OPTICAL CENTERVILLE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:STORE GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-435-2437
Mailing Address - Street 1:101 E ALEX BELL RD
Mailing Address - Street 2:#120
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-2753
Mailing Address - Country:US
Mailing Address - Phone:937-435-2437
Mailing Address - Fax:
Practice Address - Street 1:101 E ALEX BELL RD
Practice Address - Street 2:#120
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-2753
Practice Address - Country:US
Practice Address - Phone:937-435-2437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier