Optical Boutique And Eyecare
Optometrist in Desoto, TX. Organization (NPI-2).
NPI number1407472376
StatusActive
Last updated in NPPESNov 9, 2020
Details
- NPI
- 1407472376
- Entity type
- Organization (NPI-2)
- Legal business name
- Optical Boutique And Eyecare
- Organization subpart
- No
- Enumeration date
- Jun 17, 2020
- Certification date
- Nov 9, 2020
- Last updated
- Nov 9, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 152W00000X | Optometrist | – | – | Yes |
| 152WC0802X | Optometrist, Corneal and Contact Management | – | – | |
| 156FX1201X | Technician/Technologist, Optometric Assistant | – | – | |
| 156FX1202X | Technician/Technologist, Optometric Technician | – | – | |
| 156FX1800X | Technician/Technologist, Optician | – | – |
Practice location
1233 E Pleasant Run Rd Ste ADesoto, TX 75115-4200
Phone 972-223-2020 · Fax 972-228-1860
Mailing address
Po Box 444Lancaster, TX 75146-0444
Phone 972-223-2020 · Fax 972-228-1860
Authorized official
Danielle Gloster
Owner
9722232020
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