Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 8752 | TX |
NPI | 1003291873 |
---|---|
Provider Name | Dr. Ryan Edward Hazlehurst |
First Address | Little Elm, TX 75068-5582 |
Second Address | Little Elm, TX 75068-5582 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2015 |
Last Update Date | 22/07/2015 |