=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467530980
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RPK UNLIMITED, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 03/05/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 106 MIERS ST STE A
-----------------------------------------------------
City | DEL RIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78840-3082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-775-6567
-----------------------------------------------------
Fax | 830-775-3503
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 106 MIERS ST STE A
-----------------------------------------------------
City | DEL RIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78840-3082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-775-6567
-----------------------------------------------------
Fax | 830-775-3503
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF OPTOMETRIST
-----------------------------------------------------
Name | DR. RON P KAISER
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 830-775-6567
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 6160TG
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------