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General NPI Number Information
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NPI Number | 1326490152
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Entity Type | Organization
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Legal Business Name | GESU OPTICAL LLC
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Dates
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Enumeration Date | 07/05/2016
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Last Update Date | 07/05/2016
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Provider Practice Location Address
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Address Line | 835 E LAMAR BLVD SUITE 469
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City | ARLINGTON
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State | TX
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Zip | 76011-3504
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Country | US
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Telephone | 817-385-0044
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Fax |
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Provider Business Mailing Address
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Address Line | 2111 S COLLINS ST STE 204
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City | ARLINGTON
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State | TX
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Zip | 76010-8548
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Country | US
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Telephone | 817-385-0044
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Fax | 817-549-8340
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Authorized Official
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Title or Position | CERTIFIED OPTICIAN
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Name | KIRSTEN ELISE DUNN
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Credential |
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Telephone | 817-807-2873
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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