Individual
MRS. KACY HUFFMAN PATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
5000 COLLINWOOD AVE, FORT WORTH, TX 76107-3606
(817) 732-5593
Mailing address
317 MATHESON CT, COPPELL, TX 75019-2270
(972) 393-2352
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
06401TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
167384003
—
TX
01
—
TXB153530
MEDICARE PTAN
TX
Enumeration date
06/19/2006
Last updated
09/29/2020
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