Provider Demographics
NPI:1407509177
Name:WESTSIDE VISION, LLC
Entity Type:Organization
Organization Name:WESTSIDE VISION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:517-285-1408
Mailing Address - Street 1:7785 WARNER ST
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-9632
Mailing Address - Country:US
Mailing Address - Phone:517-285-1408
Mailing Address - Fax:
Practice Address - Street 1:833 LEONARD ST NW STE B
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-4163
Practice Address - Country:US
Practice Address - Phone:616-458-7978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty