Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 5247TG | TX |
NPI | 1013013051 |
---|---|
Provider Name | Tami Lea Hannaman |
First Address | Southlake, TX 76092 |
Second Address | Southlake, TX 76092 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
921463 | BLOCK VISION (01) | TX |
TX5247 | EYE MED (01) | TX |
U78357 | (02) |