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General NPI Number Information
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NPI Number | 1700152642
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Entity Type | Individual
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Provider Name | MRS. SYLVIA DALE BICKHAM
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Gender | Female
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Dates
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Enumeration Date | 03/26/2012
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Last Update Date | 03/26/2012
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Provider Practice Location Address
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Address Line | 1502 STRICKLAND DR STE 2
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City | ORANGE
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State | TX
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Zip | 77630
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Country | US
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Telephone | 409-883-5956
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Fax | 409-882-5473
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Provider Business Mailing Address
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Address Line | 1502 STRICKLAND DR STE 2
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City | ORANGE
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State | TX
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Zip | 77630-2978
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Country | US
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Telephone | 409-883-5956
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Fax | 409-883-5473
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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