Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2500T | TX |
NPI | 1013078203 |
---|---|
Provider Name | Dr. Terry Lee Schitoskey |
First Address | Odessa, TX 79762-5947 |
Second Address | Odessa, TX 79762-5947 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 15/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
093236001 | (05) | TX |
T91291 | (02) | TX |