Doctor Name: | MR. DAVID BLACK |
NPI Number: | 1053536417 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 172500 |
Business Practice Address: | 1123 Woodbank Dr Seabrook, TX - 775864014 |
Business Phone Number: | 2813803977 |
Business Fax Number: | |
Mailing Address: | 1123 Woodbank Dr, SEABROOK |
State: | TX |
Postal Code: | 775864014 |
Phone Number: | 2813803977 |
Fax Number: | |
NPI Enumeration Date: | 04/13/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | 172500 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |