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General NPI Number Information
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NPI Number | 1154888196
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Entity Type | Organization
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Legal Business Name | OPTIO, PLLC
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Dates
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Enumeration Date | 02/26/2019
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Last Update Date | 02/26/2019
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Provider Practice Location Address
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Address Line | 2211 E SOUTHLAKE BLVD STE 525
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City | SOUTHLAKE
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State | TX
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Zip | 76092-1533
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Country | US
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Telephone | 817-873-6810
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Fax | 817-766-7026
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Provider Business Mailing Address
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Address Line | 2007 IRVING PL
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City | WICHITA FALLS
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State | TX
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Zip | 76308-2031
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Country | US
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Telephone | 940-782-6598
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Fax |
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MRS. JOELY KATE ANDERSON
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Credential |
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Telephone | 940-782-6598
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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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Taxonomy #2
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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License Number State |
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