Provider Demographics
NPI:1235564592
Name:HORIZON FAMILY OPTICAL
Entity Type:Organization
Organization Name:HORIZON FAMILY OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:915-852-2861
Mailing Address - Street 1:125 N KENAZO AVE STE F
Mailing Address - Street 2:
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-5401
Mailing Address - Country:US
Mailing Address - Phone:915-852-2861
Mailing Address - Fax:915-852-2861
Practice Address - Street 1:125 N KENAZO AVE STE F
Practice Address - Street 2:
Practice Address - City:HORIZON CITY
Practice Address - State:TX
Practice Address - Zip Code:79928-5401
Practice Address - Country:US
Practice Address - Phone:915-852-2861
Practice Address - Fax:915-852-2861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier