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General NPI Number Information
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NPI Number | 1093592933
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Entity Type | Organization
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Legal Business Name | DR. TERRY L. BOLEN, OPTOMETRIST, PLLC
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Dates
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Enumeration Date | 09/13/2023
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 600 HEWITT DR
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City | WACO
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State | TX
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Zip | 76712-6654
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Country | US
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Telephone | 254-339-1000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 122
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City | HEWITT
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State | TX
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Zip | 76643-0122
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Country | US
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Telephone | 254-339-1000
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TERRY LEE BOLEN
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Credential | O.D.
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Telephone | 775-750-7542
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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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