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General NPI Number Information
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NPI Number | 1881236008
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Entity Type | Organization
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Legal Business Name | DR. ANWI ETAME OD PROFESSIONAL OPTOMETRIC CORPORATION
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Dates
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Enumeration Date | 10/09/2019
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Last Update Date | 10/19/2019
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Provider Practice Location Address
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Address Line | 900 S MAIN ST STE 351
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City | KELLER
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State | TX
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Zip | 76248-7024
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Country | US
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Telephone | 817-527-9800
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Fax | 817-993-4033
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Provider Business Mailing Address
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Address Line | 2012 CEDAR RIDGE DR
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City | KELLER
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State | TX
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Zip | 76248-8355
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Country | US
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Telephone | 503-809-9624
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Fax |
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Authorized Official
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Title or Position | O.D./ OPTOMETRIST
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Name | ANWI NGANDO ETAME
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Credential | O.D.
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Telephone | 503-809-9624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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