Provider Demographics
NPI:1508130626
Name:WEST, DORRIS FAYE (LIC OPTICIAN)
Entity Type:Individual
Prefix:
First Name:DORRIS
Middle Name:FAYE
Last Name:WEST
Suffix:
Gender:F
Credentials:LIC OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SOUTH OAK STREET
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:AR
Mailing Address - Zip Code:72150
Mailing Address - Country:US
Mailing Address - Phone:870-942-5171
Mailing Address - Fax:870-942-5171
Practice Address - Street 1:103 SOUTH OAK STREET
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:AR
Practice Address - Zip Code:72150
Practice Address - Country:US
Practice Address - Phone:870-942-5171
Practice Address - Fax:870-942-5171
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL-068837156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician