Healthcare Provider Details

I. General information

NPI: 1205316890
Provider Name (Legal Business Name): KATHERINE DENNEY ABOC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 W MAIN ST STE 200-107
ALLEN TX
75013-8094
US

IV. Provider business mailing address

202 W MAIN ST STE 200-107
ALLEN TX
75013-8094
US

V. Phone/Fax

Practice location:
  • Phone: 469-249-0044
  • Fax:
Mailing address:
  • Phone: 469-249-0044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number222519
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: