| Organization Name: | EAST TEXAS OPTICAL, INC |
| NPI Number: | 1619001013 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RICHARD EDWARD LISKE (PRESIDENT) |
| Mailing Address: | 2476 W State Highway 154 Quitman |
| State: | TX US |
| Postal Code: | 757835587 |
| Phone Number: | 9038782451 |
| Fax Number: | 9038782933 |
| NPI Enumeration Date: | 03/15/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |