Individual
JUANITA VINCENTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
7108 CAMP BOWIE BLVD, FORT WORTH, TX 76116-7121
(817) 738-3191
(817) 738-7724
Mailing address
7108 CAMP BOWIE BLVD, FORT WORTH, TX 76116-7198
(817) 738-3191
(817) 738-7724
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
7470T
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7470T
TEXAS OPTOMETRY BOARD
—
Enumeration date
12/01/2009
Last updated
03/30/2020
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