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General NPI Number Information
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NPI Number | 1417973280
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Entity Type | Organization
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Legal Business Name | BATES & HARRIS O D INC
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 07/03/2013
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Provider Practice Location Address
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Address Line | 505 E MOCKINGBIRD LN
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City | VICTORIA
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State | TX
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Zip | 77904-2043
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Country | US
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Telephone | 361-578-2904
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Fax | 361-578-7931
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Provider Business Mailing Address
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Address Line | 505 E MOCKINGBIRD LN
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City | VICTORIA
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State | TX
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Zip | 77904-2043
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Country | US
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Telephone | 361-578-2904
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Fax | 361-578-7931
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Authorized Official
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Title or Position | OWNER
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Name | DR. LOREN C WAKHAM
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Credential | OD
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Telephone | 361-578-2904
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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 | 3433T
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License Number State | TX
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