Organization · NPI-2

Childress Vision Clinic

Optometrist · Longview, TX

NPI number1104003581
StatusActive
Last updated in NPPESJan 31, 2008

Details

NPI
1104003581
Entity type
Organization (NPI-2)
Legal business name
Childress Vision Clinic
Organization subpart
No
Enumeration date
Jan 28, 2008
Last updated
Jan 31, 2008

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
152W00000X Optometrist1892TXYes

Practice location

408 E Magrill St
Longview, TX 75601-6444

Phone 903-753-4436 · Fax 903-757-4400

Mailing address

408 E Magrill St
Longview, TX 75601-6444

Phone 903-753-4436 · Fax 903-757-4400

Authorized official

Carl Wayne Childress
Owner
9037534436

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