Provider Demographics
NPI:1548347255
Name:WESTRUM OPTOMETRY PLC
Entity type:Organization
Organization Name:WESTRUM OPTOMETRY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:WESTRUM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:515-282-5005
Mailing Address - Street 1:315 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1916
Mailing Address - Country:US
Mailing Address - Phone:515-282-5005
Mailing Address - Fax:515-282-2010
Practice Address - Street 1:315 E 5TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1916
Practice Address - Country:US
Practice Address - Phone:515-282-5005
Practice Address - Fax:515-282-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02344152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0497784Medicaid