Provider Demographics
NPI:1326045931
Name:WESTRICK, JOSEPH GERARD (OD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:GERARD
Last Name:WESTRICK
Suffix:
Gender:M
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:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46725-0187
Mailing Address - Country:US
Mailing Address - Phone:260-244-7542
Mailing Address - Fax:260-244-4638
Practice Address - Street 1:513 NORTH LINE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA CITY
Practice Address - State:IN
Practice Address - Zip Code:46725-0187
Practice Address - Country:US
Practice Address - Phone:260-244-7542
Practice Address - Fax:260-244-4638
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-29
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002764A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5213022OtherAETNA
IN410049051OtherRAILROAD MEDICARE
IN000000631685OtherBCBS
IN000000631685OtherBCBS
IN5577580001Medicare NSC
IN668800Medicare PIN