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General NPI Number Information
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NPI Number | 1003576679
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Entity Type | Organization
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Legal Business Name | FIRST IMPRESSIONS OPTOMETRIC ASSOCIATES, LLC
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Dates
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Enumeration Date | 12/23/2021
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 1825 E 80TH AVE
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City | MERRILLVILLE
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State | IN
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Zip | 46410-5750
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Country | US
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Telephone | 219-791-0951
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Fax | 219-791-9043
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Provider Business Mailing Address
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Address Line | 175 E HOUSTON ST
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City | SAN ANTONIO
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State | TX
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Zip | 78205-2255
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Country | US
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Telephone | 726-444-4078
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AJA BOWLING
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Credential | OD
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Telephone | 726-444-4078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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