Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 5608TG | TX |
NPI | 1003892068 |
---|---|
Provider Name | Dr. Javier Renee Zamora |
First Address | Round Rock, TX 78664-4309 |
Second Address | Round Rock, TX 78664-4309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2005 |
Last Update Date | 14/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100806201 | (05) | TX |
100806202 | (05) | TX |
U71686 | (02) | TX |