Individual
MRS. JANICE KAY FAULKNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OPTICIAN OWNER
Contact information
Practice address
1223 5TH AVE, FORT WORTH, TX 76104
(817) 870-1291
(817) 870-4928
Mailing address
1223 5TH AVE, FORT WORTH, TX 76104
(817) 870-1291
(817) 870-4928
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
DR3962
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
066429401
—
TX
Enumeration date
02/15/2007
Last updated
07/01/2008
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