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General NPI Number Information
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NPI Number | 1982041562
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Entity Type | Organization
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Legal Business Name | EYES ON CAMP BOWIE, PA
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Dates
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Enumeration Date | 05/23/2013
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Last Update Date | 05/23/2013
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Provider Practice Location Address
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Address Line | 6333 CAMP BOWIE BLVD SUITE 272
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City | FORT WORTH
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State | TX
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Zip | 76116-5448
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Country | US
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Telephone | 817-738-9301
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Fax |
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Provider Business Mailing Address
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Address Line | 8918 MAGNOLIA VALE DR
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City | GRANBURY
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State | TX
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Zip | 76049-4135
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Country | US
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Telephone | 817-894-9319
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | MISS CINDY M ZIMMERMAN
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Credential | OD
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Telephone | 817-894-9319
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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 | 7249TG
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License Number State | TX
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