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General NPI Number Information
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NPI Number | 1154759454
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Entity Type | Organization
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Legal Business Name | AMARILLO I CARE, PC
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Dates
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Enumeration Date | 10/23/2013
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Last Update Date | 10/23/2013
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Provider Practice Location Address
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Address Line | 3501 S SONCY RD SUITE 100
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City | AMARILLO
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State | TX
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Zip | 79119-6407
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Country | US
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Telephone | 806-352-3157
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Fax | 806-358-0041
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Provider Business Mailing Address
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Address Line | 3501 S SONCY RD SUITE 100
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City | AMARILLO
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State | TX
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Zip | 79119-6407
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Country | US
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Telephone | 806-352-3157
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Fax | 806-358-0041
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Authorized Official
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Title or Position | CEO
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Name | CHRISTINE ENGLISH O'CONNOR
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Credential | OD
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Telephone | 803-352-3157
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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 | 4641TG
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License Number State | TX
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