| NPI | 1417146994 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRODERICK MOSES Optometrist 832-859-2394 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 6684TG) |
| Additional Taxonomies | 261Q00000X (Licence: LA 1383-519T) |
| 261Q00000X (Licence: TX 6684TG) | |
| Enumeration Date | 2007-10-19 |
| Last Update Date | 2019-02-19 |