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General NPI Number Information
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NPI Number | 1023561727
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Entity Type | Organization
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Legal Business Name | ART OF VISION CLINIC
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Dates
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Enumeration Date | 07/28/2016
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Last Update Date | 07/28/2016
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Provider Practice Location Address
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Address Line | 2245 JACKSBORO HWY
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City | FORT WORTH
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State | TX
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Zip | 76114-2319
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Country | US
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Telephone | 682-707-7730
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Fax |
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Provider Business Mailing Address
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Address Line | 2245 JACKSBORO HWY
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City | FORT WORTH
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State | TX
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Zip | 76114-2319
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Country | US
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Telephone | 682-707-7730
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DONTE HICKS
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Credential | O.D.
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Telephone | 682-707-7730
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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 | 8418TG
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License Number State | TX
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