Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 10281T | TX |
NPI | 1013688472 |
---|---|
Provider Name | Brianna Lee Sooy |
First Address | Mission, TX 78572-2425 |
Second Address | Mission, TX 78572-2425 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2021 |
Last Update Date | 24/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10281T | LICENSE (01) | TX |