Provider Demographics
NPI:1730225608
Name:WEST, MICHAEL LOYAL (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LOYAL
Last Name:WEST
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 1:650 EAST UNION SQUARE
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-3403
Mailing Address - Country:US
Mailing Address - Phone:801-572-3937
Mailing Address - Fax:801-572-9849
Practice Address - Street 1:650 EAST UNION SQUARE
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-3403
Practice Address - Country:US
Practice Address - Phone:801-572-3937
Practice Address - Fax:801-572-9849
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT111824-8908152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT6422OtherAVESIS
UTEYEMEDOtherUT1824
UT31302DOtherDAVIS VISION
UT87041952600001OtherREGENCE BLUE CROSS
UT265244OtherALTIUS
UTEYEMEDOtherUT1824
UT$$$$$$$$$000Medicaid
UTT78140Medicare UPIN
UTEYEMEDOtherUT1824