Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 4175TG | TX |
NPI | 1003974429 |
---|---|
Provider Name | Lynette Hyland Braun |
First Address | Dallas, TX 75225 |
Second Address | Dallas, TX 75225 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 04/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U60510 | (02) | TX |