Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 6024T | TX |
NPI | 1003914524 |
---|---|
Provider Name | Alycia N Green |
First Address | Mckinney, TX 75071-7668 |
Second Address | Colleyville, TX 76034-6221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 20/09/2017 |