NPI age
7 years
Enumerated 2019-04-02
Across 2155 active ophthalmology providers in Texas.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (KS) | 94-10400 | KANSAS STATE LICENSE |
| 01 (MO) | 2020017973 | MISSOURI STATE LICENSE |
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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