NPI age
19 years
Enumerated 2006-08-05
Across 7867 active optometrist providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 03802TG | OPTOMETRY BOARD LICENSE # |
| 01 (TX) | 1336326966 | GROUP NPI NUMBER |
| 01 (TX) | MH0879063 | DHE |
| 01 (TX) | W0122304 | DPS |
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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