Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 7974TG | TX |
NPI | 1003153958 |
---|---|
Provider Name | Dr. Rien Broussard Thomas |
First Address | Pearland, TX 77584-9720 |
Second Address | Pearland, TX 77584-9720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2013 |
Last Update Date | 08/11/2016 |