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General NPI Number Information
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NPI Number | 1386762094
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Entity Type | Individual
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Provider Name | FRANK MCILWAIN O.D.
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Gender | Male
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 620 INTERSTATE 20 SERVICE ROAD
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City | WASKOM
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State | TX
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Zip | 75692-0236
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Country | US
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Telephone | 903-687-3680
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 236
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City | WASKOM
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State | TX
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Zip | 75692-0236
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Country | US
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Telephone | 903-687-3680
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WX0102X
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Taxonomy Name | Occupational Vision Optometrist
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License Number | 2737T
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License Number State | TX
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