Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WV0400X | Optomitrist - Vision Therapist | 9500T | TX |
NPI | 1992274278 |
---|---|
Provider Name | Dorian David Acosta |
First Address | Pearland, TX 77584-7143 |
Second Address | Pasadena, TX 77505-3950 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2018 |
Last Update Date | 16/11/2018 |