MEDICARE: JAMES DAVID MUNDT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician

General Provider Information

NPI Number	:	1013184597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES DAVID MUNDT

Provider Business Mailing Address
First Line	:	5401 FM 1626
Second Line	:	STE 135
City	:	KYLE
State	:	TX
Zip	:	78640-6038
Country	:	US
Telephone Number	:	512-268-7850
Fax Number	:

Provider Business Practice Location Address
First Line	:	5401 FM 1626
Second Line	:	STE 135
City	:	KYLE
State	:	TX
Zip	:	78640-6038
Country	:	US
Telephone Number	:	512-268-7850
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2008
Last Update Date	:	05/13/2008

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Directions to “ JAMES DAVID MUNDT ” Practice Location

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