Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DR4127 | TX |
NPI | 1164853453 |
---|---|
Provider Name | Robert Montgomery SR. |
First Address | Lufkin, TX 75904-3127 |
Second Address | Lufkin, TX 75904-3127 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2013 |
Last Update Date | 11/12/2013 |