Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 163732 |
NPI | 1144522962 |
---|---|
Provider Name | Victor A Rubio |
First Address | Horizon City, TX 79928-8579 |
Second Address | Horizon City, TX 79928-8579 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2010 |
Last Update Date | 30/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
163732 | CETIFIED OPTICIAN ABOC (01) |