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General NPI Number Information
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NPI Number | 1790088243
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Entity Type | Organization
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Legal Business Name | TAYLOR R. BROOKS, O.D, P.C
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Dates
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Enumeration Date | 12/06/2010
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Last Update Date | 05/19/2011
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Provider Practice Location Address
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Address Line | 1650 W NORTHWEST HWY SUITE 202
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City | GRAPEVINE
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State | TX
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Zip | 76051-8109
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Country | US
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Telephone | 817-552-0252
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Fax | 817-552-0255
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Provider Business Mailing Address
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Address Line | 1650 W NORTHWEST HWY SUITE 202
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City | GRAPEVINE
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State | TX
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Zip | 76051-8109
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Country | US
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Telephone | 817-552-0252
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Fax | 817-552-0255
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. AMY ANN BROOKS
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Credential |
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Telephone | 817-552-0252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 5555T
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License Number State | TX
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