Provider Demographics
NPI:1932173978
Name:WEST, STEPHEN B (OD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:B
Last Name:WEST
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 GETTYSBURG PIKE
Mailing Address - Street 2:SUITE C200
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-5205
Mailing Address - Country:US
Mailing Address - Phone:717-796-2000
Mailing Address - Fax:717-796-2015
Practice Address - Street 1:555 GETTYSBURG PIKE
Practice Address - Street 2:SUITE C200
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-5201
Practice Address - Country:US
Practice Address - Phone:717-796-2000
Practice Address - Fax:717-796-2015
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE007242T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA629113Medicare PIN
PAU03089Medicare UPIN