Individual
MRS. BLANCA E LICON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1830 GEORGE DIETER DR STE 103, EL PASO, TX 79936-4305
(915) 855-4244
(915) 855-4580
Mailing address
1830 GEORGE DIETER DR STE 103, EL PASO, TX 79936-4305
(915) 855-4244
(915) 855-4580
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
CP00354
TX
Other
Enumeration date
07/20/2007
Last updated
07/20/2007
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