Provider Demographics
NPI:1356508436
Name:POOLE, MOHAN VALENTINO (OD)
Entity Type:Individual
Prefix:MR
First Name:MOHAN
Middle Name:VALENTINO
Last Name:POOLE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:12531 W HIGHWAY 71
Mailing Address - Street 2:#4201
Mailing Address - City:BEE CAVE
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6640
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:614 7TH ST
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-5819
Practice Address - Country:US
Practice Address - Phone:830-693-3292
Practice Address - Fax:830-693-8365
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-17
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX7274 TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist