Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 7455T | TX |
NPI | 1003048851 |
---|---|
Provider Name | Jennifer N. Bird |
First Address | Katy, TX 77494-5713 |
Second Address | Katy, TX 77494-5713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2009 |
Last Update Date | 29/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7455T | TEXAS OPTOMETRY LICENSE (01) | TX |
TXB142479 | INDIVIDUAL PTAN (01) |