Provider Demographics
NPI:1205380425
Name:WEST, MARANDA AMORNYARD (OD)
Entity Type:Individual
Prefix:
First Name:MARANDA
Middle Name:AMORNYARD
Last Name:WEST
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 W 1ST AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1261
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1595 GEORGESVILLE SQUARE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-3689
Practice Address - Country:US
Practice Address - Phone:614-385-0088
Practice Address - Fax:614-853-2442
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6438152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist