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General NPI Number Information
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NPI Number | 1699711713
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Entity Type | Organization
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Legal Business Name | TOM J. SHIREY, O.D., P.A.
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 07/22/2008
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Provider Practice Location Address
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Address Line | 6770 WESTWORTH BLVD. SUITE 600
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City | FORT WORTH
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State | TX
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Zip | 76114
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Country | US
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Telephone | 817-246-3177
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Fax | 817-246-3277
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Provider Business Mailing Address
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Address Line | 6770 WESTWORTH BLVD. SUITE 600
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City | FORT WORTH
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State | TX
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Zip | 76114
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Country | US
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Telephone | 817-246-3177
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Fax | 817-246-3277
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. TOM J. SHIREY
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Credential | O.D.
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Telephone | 817-246-3177
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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 | 2758
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License Number State | TX
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