Organization
KING AND ROSE OPTICAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DREW PROVOST O.D. (CEO)
(737) 484-1512
Entity
Organization
Contact information
Practice address
6701 BURNET RD, SUITE C2, AUSTIN, TX 78757-2855
(737) 484-1512
Mailing address
6701 BURNET RD, SUITE C2, AUSTIN, TX 78757-2855
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
7799-T
TX
Other
Enumeration date
10/06/2016
Last updated
10/06/2016
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