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General NPI Number Information
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NPI Number | 1780913590
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Entity Type | Organization
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Legal Business Name | ABILENE OPTOMETRY PA
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Dates
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Enumeration Date | 12/08/2009
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Last Update Date | 05/11/2023
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Provider Practice Location Address
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Address Line | 9002 N NAVARRO ST
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City | VICTORIA
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State | TX
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Zip | 77904-1431
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Country | US
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Telephone | 361-485-0928
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Fax | 361-371-4467
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Provider Business Mailing Address
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Address Line | 9002 N NAVARRO ST
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City | VICTORIA
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State | TX
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Zip | 77904-1431
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Country | US
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Telephone | 361-485-0928
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Fax | 361-371-4467
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JONATHAN H TAN
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Credential | OD
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Telephone | 361-485-0928
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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 | 6815TG
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License Number State | TX
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