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General NPI Number Information
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NPI Number | 1013156694
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Entity Type | Organization
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Legal Business Name | DUMAS VISION SOURCE, PLLC
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Dates
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Enumeration Date | 02/05/2009
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Last Update Date | 11/08/2018
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Provider Practice Location Address
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Address Line | 1301 E 1ST ST
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City | DUMAS
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State | TX
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Zip | 79029-3567
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Country | US
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Telephone | 806-935-2020
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Fax | 806-934-9908
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Provider Business Mailing Address
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Address Line | 1301 E 1ST ST
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City | DUMAS
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State | TX
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Zip | 79029-3567
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Country | US
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Telephone | 806-935-2020
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Fax | 806-934-9908
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Authorized Official
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Title or Position | OWNER
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Name | DR. TORY WAYNE MOORE
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Credential | O.D.
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Telephone | 806-935-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4305TG
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License Number State | TX
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