Healthcare Provider Details

I. General information

NPI: 1548415938
Provider Name (Legal Business Name): LINDA HOLLIBAUGH ABOC, RDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2008
Last Update Date: 11/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5805 HIGHWAY BLVD SUITE A
KATY TX
77494-1206
US

IV. Provider business mailing address

5805 HWY BLVD SUITE A
KATY TX
77494
US

V. Phone/Fax

Practice location:
  • Phone: 281-391-3111
  • Fax: 281-391-3110
Mailing address:
  • Phone: 281-391-3111
  • Fax: 281-391-3110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberDR4079
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number268
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number12713
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: