| NPI | 1265781553 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA KAY FORTENBERRY Owner 210-417-4177 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 7062T) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: TX 7062T) |
| 152WL0500X Optometrist Low Vision Rehabilitation (Licence: TX 7062T) | |
| 152WP0200X Optometrist Pediatrics (Licence: TX 7062T) | |
| 152WS0006X Optometrist Sports Vision (Licence: TX 7062T) | |
| 152WV0400X Optometrist Vision Therapy (Licence: TX 7062T) | |
| 152WX0102X Optometrist Occupational Vision (Licence: TX 7062T) | |
| 156F00000X Technician/Technologist (Licence: TX 7062T) | |
| 156FC0800X Technician/Technologist Contact Lens (Licence: TX 7062T) | |
| 156FC0801X Technician/Technologist Contact Lens Fitter (Licence: TX 7062T) | |
| 156FX1100X Technician/Technologist Ophthalmic (Licence: TX 7062T) | |
| 156FX1101X Technician/Technologist Ophthalmic Assistant (Licence: TX 7062T) | |
| 156FX1202X Technician/Technologist Optometric Technician (Licence: TX 7062T) | |
| 156FX1700X Technician/Technologist Ocularist (Licence: TX 7062T) | |
| 156FX1800X Technician/Technologist Optician (Licence: TX 7062T) | |
| Enumeration Date | 2012-09-03 |
| Last Update Date | 2014-11-05 |