Healthcare Provider Details

I. General information

NPI: 1386762094
Provider Name (Legal Business Name): FRANK MCILWAIN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 INTERSTATE 20 SERVICE ROAD
WASKOM TX
75692-0236
US

IV. Provider business mailing address

PO BOX 236
WASKOM TX
75692-0236
US

V. Phone/Fax

Practice location:
  • Phone: 903-687-3680
  • Fax:
Mailing address:
  • Phone: 903-687-3680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number2737T
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: