Provider Demographics
NPI:1386605632
Name:WEST, SANDRA T (OD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:T
Last Name:WEST
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 BEECH AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1076
Mailing Address - Country:US
Mailing Address - Phone:215-782-8799
Mailing Address - Fax:215-782-8799
Practice Address - Street 1:1714 BEECH AVE
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1076
Practice Address - Country:US
Practice Address - Phone:215-782-8799
Practice Address - Fax:215-782-8799
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG 1060152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001460462 0005Medicaid
PA069637200OtherKHPE
PA753973OtherAMERIHEALTH
PAWE753973OtherBCBS PA
PA15194OtherHEALTHPARTNERS
PAPA1060OtherEYEMED
PA1047722OtherKMHP
PA44012OtherDAVIS VISION
PA472579OtherAETNA
PAWE753973OtherBCBS PA
PA1047722OtherKMHP