Provider Demographics
NPI:1710420161
Name:WEST POINT OPTICAL GROUP
Entity Type:Organization
Organization Name:WEST POINT OPTICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-545-4465
Mailing Address - Street 1:62 FOUNDERS PKWY STE E
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-7535
Mailing Address - Country:US
Mailing Address - Phone:303-688-1146
Mailing Address - Fax:
Practice Address - Street 1:4987 FACTORY SHOPS BLVD UNIT 120
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-3344
Practice Address - Country:US
Practice Address - Phone:303-688-1146
Practice Address - Fax:303-688-1164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-02
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty