Organization
BRAZOS PROF. OPT.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LESTER A PROVE (OWNER)
(979) 776-7111
Entity
Organization
Contact information
Practice address
2901 E 29TH ST STE 105, BRYAN, TX 77802-2691
(979) 776-7111
(979) 776-7112
Mailing address
2901 E 29TH ST STE 105, BRYAN, TX 77802-2691
(979) 776-7111
(979) 776-7112
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09779001
—
TX
Enumeration date
05/15/2008
Last updated
07/29/2008
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