=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932366655
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NICHOLE Q SOTO OD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2008
-----------------------------------------------------
Last Update Date | 01/17/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2740 HIGHWAY 35 N
-----------------------------------------------------
City | ROCKPORT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78382-5709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-729-2020
-----------------------------------------------------
Fax | 361-729-4525
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2740 HIGHWAY 35 N
-----------------------------------------------------
City | ROCKPORT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78382-5709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-729-2020
-----------------------------------------------------
Fax | 361-729-4525
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. NICHOLE Q SOTO
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 361-729-2020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------