Provider Demographics
NPI:1245448760
Name:WESTBROOK, JAMES DEWEY (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DEWEY
Last Name:WESTBROOK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 LOVELL JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-7433
Mailing Address - Country:US
Mailing Address - Phone:601-798-7527
Mailing Address - Fax:
Practice Address - Street 1:910 23RD AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-5017
Practice Address - Country:US
Practice Address - Phone:601-693-1841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS536152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00087104Medicaid
MS00087104Medicaid