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General NPI Number Information
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NPI Number | 1306372776
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Entity Type | Organization
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Legal Business Name | SIGNATURE EYEWEAR,LLC
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Dates
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Enumeration Date | 05/04/2017
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Last Update Date | 05/04/2017
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Provider Practice Location Address
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Address Line | 121 AVENUE B NW
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City | CHILDRESS
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State | TX
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Zip | 79201-4513
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Country | US
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Telephone | 940-537-1376
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 256
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City | CHILDRESS
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State | TX
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Zip | 79201-0256
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTICIAN
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Name | JOHN A BISHOP
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Credential |
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Telephone | 940-537-1376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 159943
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License Number State | TX
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