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General NPI Number Information
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NPI Number | 1083814610
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Entity Type | Organization
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Legal Business Name | CYNTHIA LACY-STALLWORTH, O.D. LLC
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 07/23/2007
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Provider Practice Location Address
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Address Line | 1615 S LOOP W
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City | HOUSTON
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State | TX
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Zip | 77054-4814
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Country | US
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Telephone | 713-796-2216
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Fax | 713-383-7612
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Provider Business Mailing Address
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Address Line | 1615 S LOOP W
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City | HOUSTON
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State | TX
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Zip | 77054-4814
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Country | US
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Telephone | 713-796-2216
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Fax | 713-383-7612
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | CYNTHIA LACY-STALLWORTH
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Credential | O.D.
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Telephone | 713-734-5376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 06786T
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License Number State | TX
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