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General NPI Number Information
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NPI Number | 1043902968
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Entity Type | Individual
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Provider Name | KEVIN LEE EARWOOD SR. ABOC
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Gender | Male
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Dates
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Enumeration Date | 05/22/2023
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 12220 FM 423
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City | FRISCO
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State | TX
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Zip | 75033-5222
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Country | US
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Telephone | 469-362-8763
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Fax | 469-362-5472
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Provider Business Mailing Address
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Address Line | 12220 FM 423 # F
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City | FRISCO
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State | TX
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Zip | 75033-5222
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Country | US
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Telephone | 469-362-8763
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Fax | 469-362-5472
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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