Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 2626 | AR |
Y | 152W00000X | Optometrist | 9619T | TX |
NPI | 1003044355 |
---|---|
Provider Name | Dr. Clemit W Liles III |
First Address | Prosper, TX 75078-5122 |
Second Address | Prosper, TX 75078-5122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2009 |
Last Update Date | 22/07/2021 |