Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 7109TG | TX |
NPI | 1003001298 |
---|---|
Provider Name | Kasey Warren |
First Address | Kyle, TX 78640 |
Second Address | Kyle, TX 78640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2007 |
Last Update Date | 10/12/2007 |