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General NPI Number Information
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NPI Number | 1639436108
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Entity Type | Organization
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Legal Business Name | EYE-DO OPTICAL, INC.
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Dates
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Enumeration Date | 04/20/2012
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Last Update Date | 04/30/2012
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Provider Practice Location Address
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Address Line | 600 E TAYLOR ST STE 210
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City | SHERMAN
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State | TX
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Zip | 75090-2844
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Country | US
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Telephone | 903-868-1135
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Fax | 903-891-0181
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Provider Business Mailing Address
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Address Line | 600 E TAYLOR ST STE 210
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City | SHERMAN
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State | TX
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Zip | 75090-2844
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Country | US
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Telephone | 903-868-1135
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Fax | 903-891-0181
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEROME E GUNDERSHEIMER
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Credential | O.D.
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Telephone | 903-868-1135
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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 | 3473TG
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 3473TG
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License Number State | TX
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