Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 5170TG | TX |
NPI | 1003902297 |
---|---|
Provider Name | Laura Zivley |
First Address | Pearland, TX 77584-7298 |
Second Address | Houston, TX 77057-2209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 24/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
045270803 | (05) | TX |
045270804 | (05) | TX |