Provider Demographics
NPI:1346450533
Name:WEST, MARY CATHERINE (OD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:CATHERINE
Last Name:WEST
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:CATHERINE
Other - Last Name:PAYTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1120 NORWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41102-5258
Mailing Address - Country:US
Mailing Address - Phone:740-612-2775
Mailing Address - Fax:
Practice Address - Street 1:313 S CAROL MALONE BLVD
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-1357
Practice Address - Country:US
Practice Address - Phone:606-474-7833
Practice Address - Fax:606-474-3563
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1719DT152W00000X
OH5648152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000530225OtherANTHEM
9866058OtherAETNA
000000530225OtherANTHEM