Individual
JERRY D. REDWINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
111 E 3RD ST, MULESHOE, TX 79347-3801
(806) 272-4705
(806) 272-3824
Mailing address
PO BOX 1011, MULESHOE, TX 79347-1011
(806) 272-4705
(806) 272-3824
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2296T
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0931693-01
—
TX
Enumeration date
02/22/2007
Last updated
01/08/2008
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