Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | NOT REQUIRED |
NPI | 1215905914 |
---|---|
Provider Name | Mr. Billy B. Chumley JR. |
First Address | Katy, TX 77492-0296 |
Second Address | Katy, TX 77493-8015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 19/03/2008 |