Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 06706TG | TX |
NPI | 1003898321 |
---|---|
Provider Name | Carroll David Dick |
First Address | Gainesville, TX 76240 |
Second Address | Gainesville, TX 76240 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2005 |
Last Update Date | 29/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
214483401 | (05) | TX |