Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | TX2326 | TX |
NPI | 1003993908 |
---|---|
Provider Name | Dr. Peter Brice Kline |
First Address | San Antonio, TX 78238-1438 |
Second Address | San Antonio, TX 78238-1438 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
741891275 | IRS INDIVIDUAL TAXPAYER I (01) | TX |