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General NPI Number Information
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NPI Number | 1881686699
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Entity Type | Organization
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Legal Business Name | JERRY NORTHCUTT, PLLC
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Dates
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Enumeration Date | 08/17/2005
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Last Update Date | 02/01/2008
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Provider Practice Location Address
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Address Line | 2405 YORKSTOWN DR
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City | ENNIS
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State | TX
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Zip | 75119-2191
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Country | US
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Telephone | 972-875-3181
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Fax | 972-875-6443
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Provider Business Mailing Address
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Address Line | 2405 YORKSTOWN DR
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City | ENNIS
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State | TX
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Zip | 75119-2191
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JERRY LEE NORTHCUTT
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Credential | OD
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Telephone | 972-875-3181
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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 | 5150TG
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License Number State | TX
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