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General NPI Number Information
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NPI Number | 1730567330
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Entity Type | Organization
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Legal Business Name | OPTIQUE EYE CARE, PLLC
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Dates
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Enumeration Date | 05/14/2015
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Last Update Date | 05/14/2015
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Provider Practice Location Address
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Address Line | 15069 IH 35 N
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City | SELMA
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State | TX
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Zip | 78154-3312
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Country | US
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Telephone | 210-232-8975
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Fax |
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Provider Business Mailing Address
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Address Line | 15069 IH 35 N
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City | SELMA
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State | TX
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Zip | 78154-3312
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | KENTARO KIKUCHI
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Credential | O.D.
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Telephone | 210-232-8975
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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 | 6896TG
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License Number State | TX
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