Individual
Inactive
Sole proprietor
Provider details
NPI number
Contact information
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1801TG
TX
152W00000X
Optometrist
TX1801
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
093032301
—
TX
Enumeration date
—
Last updated
—
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