=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780866202
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMY E. BISHOP, O.D.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2007
-----------------------------------------------------
Last Update Date | 12/07/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 125 AVENUE B NW
-----------------------------------------------------
City | CHILDRESS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79201-4513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-937-2015
-----------------------------------------------------
Fax | 940-937-6889
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 125 AVENUE B NW PO BOX 256
-----------------------------------------------------
City | CHILDRESS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79201-4513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-937-2015
-----------------------------------------------------
Fax | 940-937-6889
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | DR. AMY E BISHOP
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 940-937-2015
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number | 4950TG
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------