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General NPI Number Information
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NPI Number | 1891952594
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Entity Type | Organization
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Legal Business Name | PENA OPTICAL SOLUTIONS LLC
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 500 JUNCTION HWY
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City | KERRVILLE
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State | TX
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Zip | 78028-5065
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Country | US
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Telephone | 830-257-6336
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Fax | 830-792-4808
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Provider Business Mailing Address
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Address Line | 500 JUNCTION HWY
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City | KERRVILLE
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State | TX
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Zip | 78028-5065
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Country | US
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Telephone | 830-257-6336
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Fax | 830-792-4808
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Authorized Official
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Title or Position | DOCTOR OF OPTOMETRY
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Name | BENITO PENA
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Credential | O.D.
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Telephone | 830-257-6336
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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 | 7139TG
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License Number State | TX
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