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General NPI Number Information
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NPI Number | 1649450149
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Entity Type | Organization
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Legal Business Name | CROWN EYE CARE CENTER, P.C.
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 11/19/2008
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Provider Practice Location Address
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Address Line | 1618 W CHURCH ST
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City | LIVINGSTON
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State | TX
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Zip | 77351-9043
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Country | US
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Telephone | 936-327-6379
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Fax | 936-327-3599
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Provider Business Mailing Address
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Address Line | PO BOX 1858
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City | LIVINGSTON
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State | TX
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Zip | 77351-0035
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Country | US
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Telephone | 936-327-6379
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Fax | 936-326-3599
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHANIE MICHELE DAVIS
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Credential | O.D.
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Telephone | 832-266-9346
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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 | 5938TG
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License Number State | TX
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