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General NPI Number Information
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NPI Number | 1336326966
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Entity Type | Organization
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Legal Business Name | COLLEYVILLE VISION ASSOCIATES
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Dates
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Enumeration Date | 01/25/2008
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Last Update Date | 01/19/2012
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Provider Practice Location Address
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Address Line | 1213 HALL JOHNSON RD SUITE 300
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City | COLLEYVILLE
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State | TX
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Zip | 76034-5847
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Country | US
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Telephone | 817-428-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 1213 HALL JOHNSON RD SUITE 300
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City | COLLEYVILLE
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State | TX
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Zip | 76034-5847
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Country | US
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Telephone | 817-428-0400
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Fax |
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | MRS. CHRISTINE HICKMAN
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Credential |
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Telephone | 817-428-0400
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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 | 3802TG
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License Number State | TX
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