| NPI | 1629759089 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICIA SURRATT Credentialing Coordinator 972-258-7979 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology |
| Additional Taxonomies | 152W00000X Optometrist |
| 152WP0200X Optometrist, Pediatrics | |
| 207WX0110X Ophthalmology, Pediatric Ophthalmology and Strabismus Specialist | |
| Enumeration Date | 2023-07-28 |
| Last Update Date | 2023-07-28 |