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General NPI Number Information
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NPI Number | 1225228752
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Entity Type | Organization
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Legal Business Name | MICHELINE D TAYLOR
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Dates
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Enumeration Date | 07/31/2007
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Last Update Date | 11/19/2007
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Provider Practice Location Address
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Address Line | 304 E HIGHWAY 190
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City | COPPERAS COVE
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State | TX
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Zip | 76522-2939
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Country | US
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Telephone | 254-547-2020
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Fax | 254-542-6060
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Provider Business Mailing Address
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Address Line | 302 E HIGHWAY 190
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City | COPPERAS COVE
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State | TX
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Zip | 76522-2939
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Country | US
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Telephone | 254-547-2683
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Fax | 254-547-4099
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. MICHELINE D YOUNG
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Credential | OD
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Telephone | 254-547-2683
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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 | 3854TG
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License Number State | TX
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