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General NPI Number Information
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NPI Number | 1174842405
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Entity Type | Organization
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Legal Business Name | BIG COUNTRY OPTICAL, PLLC
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Dates
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Enumeration Date | 05/26/2010
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Last Update Date | 06/14/2010
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Provider Practice Location Address
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Address Line | 4342 TREANOR DR
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City | ABILENE
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State | TX
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Zip | 79602-7012
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Country | US
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Telephone | 325-690-5900
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Fax | 325-690-5902
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Provider Business Mailing Address
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Address Line | 4342 TREANOR DR
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City | ABILENE
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State | TX
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Zip | 79602-7012
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Country | US
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Telephone | 325-690-5900
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Fax | 325-690-5902
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Authorized Official
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Title or Position | OWNER/MD
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Name | DR. BRETTLY JOEL TEAGUE
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Credential | M.D.
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Telephone | 325-690-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State | TX
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