Provider Demographics
NPI:1558414995
Name:WEST METRO OPTICAL, LLP
Entity Type:Organization
Organization Name:WEST METRO OPTICAL, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:YANCEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-777-6333
Mailing Address - Street 1:15655 37TH AVE N STE 200
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-4008
Mailing Address - Country:US
Mailing Address - Phone:763-777-6333
Mailing Address - Fax:763-553-0891
Practice Address - Street 1:15655 37TH AVE N STE 200
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-4008
Practice Address - Country:US
Practice Address - Phone:763-777-6333
Practice Address - Fax:763-553-0891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN98F89WEOtherBLUE CROSS & BLUE SHEILD
FM101138OtherHEALTH PARTNERS
FM170703OtherUCARE MINNESOTA
MN21-00484OtherMEDICA
MN066699800Medicaid
MN3959140001Medicare NSC
MN3959140001Medicare ID - Type Unspecified