=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962323980
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EVELYN BREAK ABO CERTIFIED
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2026
-----------------------------------------------------
Last Update Date | 07/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 721 BOYD RD
-----------------------------------------------------
City | AZLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76020-4811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-270-5716
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 721 BOYD RD
-----------------------------------------------------
City | AZLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76020-4811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number | 52746360
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------