Provider Demographics
NPI:1083303903
Name:WESTFALL VISION, LLC
Entity Type:Organization
Organization Name:WESTFALL VISION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DETORE
Authorized Official - Suffix:
Authorized Official - Credentials:DMSC RPAC
Authorized Official - Phone:518-744-9911
Mailing Address - Street 1:15 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-3315
Mailing Address - Country:US
Mailing Address - Phone:518-792-5711
Mailing Address - Fax:518-792-5723
Practice Address - Street 1:15 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3315
Practice Address - Country:US
Practice Address - Phone:518-792-5711
Practice Address - Fax:518-792-5723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-05
Last Update Date:2023-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty