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General NPI Number Information
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NPI Number | 1568570323
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Entity Type | Organization
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Legal Business Name | WAXAHACHIE VISION CARE
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 03/26/2008
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Provider Practice Location Address
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Address Line | 507 N HIGHWAY 77 STE. 514
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City | WAXAHACHIE
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State | TX
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Zip | 75165-1885
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Country | US
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Telephone | 972-937-2010
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Fax | 972-923-3628
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Provider Business Mailing Address
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Address Line | 507 N HIGHWAY 77 STE. 514
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City | WAXAHACHIE
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State | TX
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Zip | 75165-1885
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Country | US
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Telephone | 972-937-2010
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Fax | 972-923-3628
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Authorized Official
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Title or Position | OPTICIAN
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Name | MR. JAMES GREG LEE
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Credential |
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Telephone | 972-937-2010
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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 | 06672TG
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License Number State | TX
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