Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DR3174 DR3175 | TX |
NPI | 1013065051 |
---|---|
Provider Name | Mr. Gary Carrera |
First Address | Universal City, TX 78148-4427 |
Second Address | Universal City, TX 78148-4427 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 20/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110510 | EYEMED VISION CARE (01) | TX |
44349 | AVESIS VISION PLAN (01) | TX |
514575 | BCBS OF TEXAS (01) | TX |
CO47384 | SPECTERA VISION (01) | TX |
FC63634 | SAFEGUARD VISION (01) | TX |