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General NPI Number Information
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NPI Number | 1861694549
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Entity Type | Organization
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Legal Business Name | TRINITY VISION CENTER,PA
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 12/01/2015
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Provider Practice Location Address
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Address Line | 1201 S MAIN ST STE 108
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City | BOERNE
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State | TX
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Zip | 78006-2833
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Country | US
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Telephone | 830-249-3898
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Fax | 830-249-9228
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Provider Business Mailing Address
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Address Line | 1201 S MAIN ST STE 108
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City | BOERNE
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State | TX
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Zip | 78006-2833
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Country | US
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Telephone | 830-249-3898
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Fax | 830-249-9228
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JUSTIN M KIM
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Credential | D.O.
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Telephone | 830-249-3898
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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 | 6310T
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License Number State | TX
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