| NPI | 1952656589 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK ALAN JOHNSON Optometrist 409-892-4790 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX TX4495) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: TX TX4495T) |
| 156F00000X Technician/Technologist (Licence: TX TX4495T) | |
| 156FC0800X Technician/Technologist, Contact Lens (Licence: TX TX4495T) | |
| 156FC0801X Technician/Technologist, Contact Lens Fitter (Licence: TX TX4495T) | |
| Enumeration Date | 2012-07-19 |
| Last Update Date | 2012-07-19 |