Individual
DR. JAN PENNINGTON WISHOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
805 PAISLEY DR, 14, BRIARCLIFF, TX 78669-2432
(512) 791-3736
Mailing address
805 PAISLEY DR, 14, BRIARCLIFF, TX 78669-2432
(512) 791-3736
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
3545TG
TX
152W00000X
Optometrist
Primary
OPC2259
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
093035603
—
TX
Enumeration date
11/18/2005
Last updated
10/04/2013
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