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General NPI Number Information
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NPI Number | 1073495792
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Entity Type | Individual
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Provider Name | BRENDA MAIER COA
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Gender | Female
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Dates
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Enumeration Date | 07/23/2025
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 2201 SE LOOP 820
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City | FORT WORTH
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State | TX
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Zip | 76119-5863
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Country | US
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Telephone | 817-730-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 7402 LAKE RIDGE PKWY APT 9121
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City | GRAND PRAIRIE
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State | TX
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Zip | 75054-0419
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Country | US
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Telephone | 817-891-9676
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Fax |
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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 | 156FX1101X
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Taxonomy Name | Ophthalmic Assistant
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License Number | 288290
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License Number State | TX
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