Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 8749TG | TX |
NPI | 1013391242 |
---|---|
Provider Name | Dr. Amanda Jo Browning Tucker |
First Address | Childress, TX 79201-1076 |
Second Address | Childress, TX 79201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2015 |
Last Update Date | 30/07/2018 |