Individual
DR. KARL R. STOTTLEMYRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
7700 FISH POND RD, WACO, TX 76710-1031
(254) 741-4444
Mailing address
PO BOX 847408, DALLAS, TX 75284-7408
(254) 724-2111
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
04718T
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0192809-02
—
TX
01
—
81061Q
BLUE SHIELD
TX
01
—
P00164576
RR/MEDICARE
TX
Enumeration date
04/03/2006
Last updated
07/11/2007
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