Provider Demographics
NPI:1356548556
Name:WESTCOTT, CLIVE (LDO)
Entity type:Individual
Prefix:MR
First Name:CLIVE
Middle Name:
Last Name:WESTCOTT
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 N 40TH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-4330
Mailing Address - Country:US
Mailing Address - Phone:509-966-9884
Mailing Address - Fax:509-965-6137
Practice Address - Street 1:506 N 40TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-4330
Practice Address - Country:US
Practice Address - Phone:509-966-9884
Practice Address - Fax:509-965-6137
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADO00000951156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1132530001Medicare NSC