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General NPI Number Information
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NPI Number | 1417128612
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Entity Type | Organization
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Legal Business Name | EVELYN K HANCOCK
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Dates
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Enumeration Date | 03/14/2008
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Last Update Date | 04/10/2008
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Provider Practice Location Address
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Address Line | 207 E SAN ANTONIO ST
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City | FREDERICKSBURG
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State | TX
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Zip | 78624-4137
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Country | US
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Telephone | 830-997-4800
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Fax | 830-990-1427
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Provider Business Mailing Address
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Address Line | 207 E SAN ANTONIO ST.
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City | FREDERICKSBURG
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State | TX
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Zip | 78624
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Country | US
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Telephone | 830-997-4800
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Fax | 830-990-1427
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Authorized Official
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Title or Position | OWNER/OPTICIAN
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Name | MRS. EVELYN K HANCOCK
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Credential |
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Telephone | 830-997-4800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 11422
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License Number State | TX
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