Individual
LOREN BAZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
6014 AZLE AVE STE 200, LAKE WORTH, TX 76135-2603
(682) 312-2603
Mailing address
1649 SANDLE WOOD DR, WEATHERFORD, TX 76087-1235
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
9179T
TX
152W00000X
Optometrist
Primary
9179TG
TX
Other
Enumeration date
05/02/2018
Last updated
06/27/2018
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