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General NPI Number Information
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NPI Number | 1699951756
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Entity Type | Organization
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Legal Business Name | OAK CREEK OPTICAL
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Dates
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Enumeration Date | 01/18/2008
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Last Update Date | 03/10/2008
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Provider Practice Location Address
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Address Line | 2615 NE LOOP 286
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City | PARIS
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State | TX
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Zip | 75460-3444
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Country | US
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Telephone | 903-785-0443
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Fax | 903-785-2947
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Provider Business Mailing Address
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Address Line | 2615 NE LOOP 286
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City | PARIS
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State | TX
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Zip | 75460-3444
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Country | US
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Telephone | 903-785-0443
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Fax | 903-785-2947
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. A LISA GROSSNICKLE
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Credential |
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Telephone | 903-785-0443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | E6388
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License Number State | TX
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