Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 6404TG | TX |
NPI | 1003824723 |
---|---|
Provider Name | Jody Lemarr-Cabano |
First Address | Corsicana, TX 75151-0615 |
Second Address | Corsicana, TX 75110-5202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 28/01/2021 |