Healthcare Provider Details

I. General information

NPI: 1417390907
Provider Name (Legal Business Name): JOHN WHORFF O.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2013
Last Update Date: 04/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 S MAIN ST
WINNSBORO TX
75494-3226
US

IV. Provider business mailing address

408 S MAIN ST
WINNSBORO TX
75494-3226
US

V. Phone/Fax

Practice location:
  • Phone: 903-342-5799
  • Fax: 903-342-1409
Mailing address:
  • Phone: 903-342-5799
  • Fax: 903-342-1409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MR. BOB WILSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 903-342-5799