Individual
GARY GLEN WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
3851 S COOPER ST, ARLINGTON, TX 76015
(817) 468-7500
(817) 557-9721
Mailing address
2250 FULLER WISER RD, 21206, EULESS, TX 76039
(817) 685-2544
(817) 557-9721
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
26497
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
917804
EYEMED
—
Enumeration date
03/28/2007
Last updated
07/08/2007
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