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General NPI Number Information
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NPI Number | 1265923361
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Entity Type | Organization
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Legal Business Name | BOERNE EYES ON MAIN PLLC
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Dates
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Enumeration Date | 05/23/2018
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 1365 S MAIN ST
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City | BOERNE
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State | TX
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Zip | 78006
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Country | US
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Telephone | 210-392-1727
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Fax |
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Provider Business Mailing Address
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Address Line | 1365 S MAIN ST
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City | BOERNE
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State | TX
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Zip | 78006-2821
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Country | US
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Telephone | 210-861-2011
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. LOREN KATHRYN RODGERS
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Credential | OD
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Telephone | 210-861-2011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | 9411T
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | 9411T
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 9411T
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License Number State | TX
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