Provider Demographics
NPI:1689743874
Name:WEST, TIFFANY SHORT (OD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:SHORT
Last Name:WEST
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:DIANE
Other - Last Name:SHORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1432 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-3926
Mailing Address - Country:US
Mailing Address - Phone:251-301-7620
Mailing Address - Fax:251-219-7835
Practice Address - Street 1:1432 HILLCREST RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-3926
Practice Address - Country:US
Practice Address - Phone:251-301-7620
Practice Address - Fax:251-219-7835
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3962-OC3698152W00000X
GAOPT001985152W00000X
ALS-890-TA-469152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALV01953Medicare UPIN
AL051523515Medicare ID - Type Unspecified