Organization
BATES & HARRIS O D INC
Active
Other names
Texas State Optical of Victoria
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LOREN C WAKHAM OD (OWNER)
(361) 578-2904
Entity
Organization
Contact information
Practice address
505 E MOCKINGBIRD LN, VICTORIA, TX 77904-2043
(361) 578-2904
(361) 578-7931
Mailing address
505 E MOCKINGBIRD LN, VICTORIA, TX 77904-2043
(361) 578-2904
(361) 578-7931
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3433T
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019365801
—
TX
Enumeration date
07/14/2006
Last updated
07/03/2013
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