Individual
DR. JERRY L LATHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2600 HARWOOD RD, BEDFORD, TX 76021-3700
(817) 571-6688
(817) 571-6906
Mailing address
1950 OLD GALLOWS RD STE 520, VIENNA, VA 22182-3970
(703) 847-8899
(571) 223-6780
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2727TG
TX
Other
Enumeration date
08/18/2005
Last updated
11/25/2020
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