Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 8688TG | TX |
NPI | 1003297417 |
---|---|
Provider Name | Stephanie Lynn Lechlitner |
First Address | Austin, TX 78701-4195 |
Second Address | Austin, TX 78701-4195 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2015 |
Last Update Date | 14/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8688TG | TEXAS STATE LICENSE NUMBER (01) | TX |