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General NPI Number Information
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NPI Number | 1063822252
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Entity Type | Organization
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Legal Business Name | STELLAR VISION CORPORATION
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Dates
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Enumeration Date | 04/28/2014
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Last Update Date | 06/14/2019
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Provider Practice Location Address
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Address Line | 735 E HIGHWAY 377
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City | GRANBURY
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State | TX
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Zip | 76048-2578
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Country | US
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Telephone | 817-964-3455
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Fax | 817-964-3465
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Provider Business Mailing Address
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Address Line | 2608 MUSEUM WAY APT 3516
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City | FORT WORTH
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State | TX
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Zip | 76107-3085
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Country | US
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Telephone | 469-417-9921
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Fax |
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Authorized Official
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Title or Position | THERAPEUTIC OPTOMETRIST
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Name | RAJAL NOORALI
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Credential | O.D.
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Telephone | 469-417-9921
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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 |
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License Number State |
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