Provider Demographics
NPI:1083713127
Name:WEST, JODIE L (OD)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:L
Last Name:WEST
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JODIE
Other - Middle Name:L
Other - Last Name:LEIBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 CRYSTAL FALLS PKWY
Mailing Address - Street 2:#4
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-3666
Mailing Address - Country:US
Mailing Address - Phone:512-260-0405
Mailing Address - Fax:512-260-0425
Practice Address - Street 1:800 CRYSTAL FALLS PKWY
Practice Address - Street 2:#4
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-3666
Practice Address - Country:US
Practice Address - Phone:512-260-0405
Practice Address - Fax:512-260-0425
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6054TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7774588OtherAETNA
TX800117058OtherUNITED HELATH CARE
TX80-0117058OtherLIFE RE
TX81163QOtherBLUE CROSS BLUE SHIELD
TX625436OtherCIGNA
TX454320OtherNVA
TX19700OtherAVESIS
TX914046OtherEYEMED
TX80-0117058OtherSUPERIOR
TX800117058OtherUNITED HELATH CARE