Provider Demographics
NPI:1073592028
Name:WEST, KEIRA RENEE (OD)
Entity Type:Individual
Prefix:DR
First Name:KEIRA
Middle Name:RENEE
Last Name:WEST
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6049 HARRIS PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4103
Mailing Address - Country:US
Mailing Address - Phone:817-294-2800
Mailing Address - Fax:817-294-1282
Practice Address - Street 1:6049 HARRIS PKWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4103
Practice Address - Country:US
Practice Address - Phone:817-294-2800
Practice Address - Fax:817-294-1282
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6055 T G152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU87691Medicare UPIN
00399PMedicare PIN