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General NPI Number Information
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NPI Number | 1508920570
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Entity Type | Organization
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Legal Business Name | KERRVILLE EYE CENTER PA
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 03/18/2011
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Provider Practice Location Address
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Address Line | 1001 WATER ST STE E100
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City | KERRVILLE
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State | TX
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Zip | 78028-3523
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Country | US
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Telephone | 830-257-4417
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Fax | 830-257-1480
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Provider Business Mailing Address
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Address Line | PO BOX 294869
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City | KERRVILLE
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State | TX
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Zip | 78029-4869
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Country | US
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Telephone | 830-257-4417
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Fax | 830-257-1480
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | RHONDA CRAVEY
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Credential |
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Telephone | 830-257-4417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | J6394
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License Number State | TX
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