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General NPI Number Information
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NPI Number | 1407020985
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Entity Type | Organization
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Legal Business Name | MANSFIELD VISION CENTER LLC
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Dates
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Enumeration Date | 04/16/2008
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Last Update Date | 04/18/2012
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Provider Practice Location Address
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Address Line | 990 HIGHWAY 287 N STE 109
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City | MANSFIELD
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State | TX
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Zip | 76063-2611
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Country | US
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Telephone | 817-453-4682
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Fax |
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Provider Business Mailing Address
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Address Line | 990 HIGHWAY 287 N STE 109
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City | MANSFIELD
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State | TX
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Zip | 76063-2611
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Country | US
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Telephone | 817-453-4682
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KYLE COOKE
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Credential |
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Telephone | 817-453-4682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 4960TG
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License Number State | TX
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