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General NPI Number Information
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NPI Number | 1194890392
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Entity Type | Organization
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Legal Business Name | NEDERLAND VISION CARE, PC
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 08/22/2007
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Provider Practice Location Address
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Address Line | 1617 S HIGHWAY 69
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City | NEDERLAND
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State | TX
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Zip | 77627-7839
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Country | US
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Telephone | 409-721-6897
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Fax | 409-729-5947
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Provider Business Mailing Address
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Address Line | 1617 S HIGHWAY 69
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City | NEDERLAND
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State | TX
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Zip | 77627-7839
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Country | US
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Telephone | 409-721-6897
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Fax | 409-729-5947
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. MARY DELINO
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Credential | O.D.
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Telephone | 409-721-6897
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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 | 4798T
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License Number State | TX
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