Individual
ETHAN DAVID ROYSTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
130 N BALLARD AVE, WYLIE, TX 75098-4467
19724299090
(972) 429-7676
Mailing address
130 N BALLARD AVE, WYLIE, TX 75098-4467
19724299090
(972) 429-7676
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
9239T
TX
Other
Enumeration date
07/10/2017
Last updated
07/10/2017
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