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General NPI Number Information
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NPI Number | 1255853644
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Entity Type | Organization
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Legal Business Name | PHYSICIANS EYE CLINIC OF LAREDO
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Dates
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Enumeration Date | 07/07/2017
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Last Update Date | 12/14/2022
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Provider Practice Location Address
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Address Line | 6999 MCPHERSON RD STE 216
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City | LAREDO
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State | TX
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Zip | 78041-6450
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Country | US
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Telephone | 956-401-6615
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Fax | 956-410-5304
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Provider Business Mailing Address
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Address Line | 6999 MCPHERSON RD STE 216
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City | LAREDO
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State | TX
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Zip | 78041-6450
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Country | US
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Telephone | 956-401-6615
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Fax | 956-410-5304
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHEN A MCNUTT
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Credential | M.D.
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Telephone | 443-695-3856
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | Q7580
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License Number State | TX
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