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General NPI Number Information
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NPI Number | 1104001643
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Entity Type | Organization
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Legal Business Name | ABILENE ADVANCED EYECARE INC.
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Dates
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Enumeration Date | 01/03/2008
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Last Update Date | 02/15/2008
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Provider Practice Location Address
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Address Line | 4734 S 14TH
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City | ABILENE
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State | TX
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Zip | 79605-4733
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Country | US
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Telephone | 325-692-9596
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Fax | 325-690-6191
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Provider Business Mailing Address
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Address Line | 4734 SOUTH 14TH
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City | ABILENE
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State | TX
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Zip | 79605-4733
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Country | US
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Telephone | 325-692-9596
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Fax | 325-690-6191
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. GABRIEL AVILA
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Credential | O.D.
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Telephone | 325-692-9596
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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 | TX6293TG
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License Number State | TX
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