MEDICARE: TSO OF GAINESVILLE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2497TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609828839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TSO OF GAINESVILLE INC

Provider Business Mailing Address
First Line	:	311 E CALIFORNIA ST
Second Line	:
City	:	GAINESVILLE
State	:	TX
Zip	:	76240-4005
Country	:	US
Telephone Number	:	940-668-7500
Fax Number	:	940-665-7377

Provider Business Practice Location Address
First Line	:	311 E CALIFORNIA ST
Second Line	:
City	:	GAINESVILLE
State	:	TX
Zip	:	76240-4005
Country	:	US
Telephone Number	:	940-668-7500
Fax Number	:	940-665-7377

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. JOHN A WEBB JR.
Credential	:	O.D.
Telephone Number	:	940-668-7500

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	03/15/2010

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