Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 8738T | TX |
NPI | 1013390079 |
---|---|
Provider Name | Xavier L Gregorio |
First Address | Spring, TX 77379-3307 |
Second Address | Spring, TX 77379-3307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2015 |
Last Update Date | 08/07/2015 |