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General NPI Number Information
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NPI Number | 1760804868
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Entity Type | Organization
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Legal Business Name | OPTIQUE INC
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Dates
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Enumeration Date | 01/09/2014
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Last Update Date | 01/09/2014
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Provider Practice Location Address
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Address Line | 3636 MCKINNEY AVE SUITE 120
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City | DALLAS
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State | TX
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Zip | 75204-1422
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Country | US
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Telephone | 214-252-1800
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Fax | 214-252-1801
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Provider Business Mailing Address
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Address Line | 3636 MCKINNEY AVE SUITE 120
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City | DALLAS
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State | TX
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Zip | 75204-1422
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Country | US
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Telephone | 214-252-1800
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Fax | 214-252-1801
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. GEORGE EVERETT ORM III
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Credential | OD
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Telephone | 214-252-1800
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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 | 2366T
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License Number State | TX
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