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General NPI Number Information
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NPI Number | 1265770887
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Entity Type | Organization
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Legal Business Name | KHARIS EYE CARE PLLC
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Dates
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Enumeration Date | 01/17/2013
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Last Update Date | 06/04/2014
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Provider Practice Location Address
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Address Line | 1104 N HIGHWAY 377 STE 200
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City | ROANOKE
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State | TX
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Zip | 76262-9124
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Country | US
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Telephone | 817-491-2018
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Fax | 817-430-2018
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Provider Business Mailing Address
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Address Line | 1104 N HIGHWAY 377 STE 200
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City | ROANOKE
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State | TX
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Zip | 76262-9124
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Country | US
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Telephone | 817-491-2018
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Fax | 817-430-2018
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Authorized Official
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Title or Position | PRESIDENT
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Name | BLAKE J HUGHES
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Credential | O.D.
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Telephone | 817-491-2018
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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 | 6934TG
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License Number State | TX
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