Provider Demographics
NPI:1114051661
Name:WESTRICH, DAVID JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOHN
Last Name:WESTRICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 S MOUNT AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-4920
Mailing Address - Country:US
Mailing Address - Phone:573-335-3577
Mailing Address - Fax:573-335-1559
Practice Address - Street 1:360 S MOUNT AUBURN RD
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4920
Practice Address - Country:US
Practice Address - Phone:573-335-3577
Practice Address - Fax:573-335-1559
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084634207WX0107X, 207W00000X
MOMDR4H61207WX0107X, 207W00000X
KY29233207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208079111Medicaid
MO4624OtherBLUE CROSS BLUE SHIELD MO
KY64038219Medicaid
KY180035396OtherRAILROAD MEDICARE
IL180035397OtherRAILROAD MEDICARE
179261OtherHEALTHLINK
MO180034566OtherRAILROAD MEDICARE
179261OtherHEALTHLINK
KY180035396OtherRAILROAD MEDICARE
MO4624OtherBLUE CROSS BLUE SHIELD MO
E56575Medicare UPIN