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General NPI Number Information
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NPI Number | 1912299470
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Entity Type | Organization
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Legal Business Name | ABILENE PROFESSIONAL EYECARE ASSOCIATES PLLC
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Dates
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Enumeration Date | 05/03/2011
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Last Update Date | 11/16/2011
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Provider Practice Location Address
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Address Line | 3225 S 27TH ST
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City | ABILENE
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State | TX
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Zip | 79605-6221
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Country | US
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Telephone | 325-691-0101
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Fax | 325-691-8950
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Provider Business Mailing Address
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Address Line | 3225 S 27TH ST
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City | ABILENE
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State | TX
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Zip | 79605-6221
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Country | US
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Telephone | 325-691-0101
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Fax | 325-691-8950
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL TODD SHANKS
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Credential | O.D.
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Telephone | 325-691-0101
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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 | 5650TG
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License Number State | TX
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