Healthcare Provider Details

I. General information

NPI: 1407930258
Provider Name (Legal Business Name): CONSOLIDATED OPTICALS OF TEXAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 04/28/2020
Certification Date: 04/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2806 S W S YOUNG DR SUITE A
KILLEEN TX
76542-2010
US

IV. Provider business mailing address

2806 S W S YOUNG DR SUITE A
KILLEEN TX
76542-2010
US

V. Phone/Fax

Practice location:
  • Phone: 254-634-4800
  • Fax: 254-634-4142
Mailing address:
  • Phone: 254-634-4800
  • Fax: 254-634-4142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. VICTORIA TAYLOR
Title or Position: GENERAL MANAGER
Credential:
Phone: 254-778-9100