Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 6694TG | TX |
NPI | 1003033812 |
---|---|
Provider Name | Lucia Ann Welding |
First Address | Southlake, TX 76092-2213 |
Second Address | Keller, TX 76248 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 28/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U67040 | (02) | MI |
U67040 | (02) | TN |