Provider Demographics
NPI:1780866202
Name:AMY E. BISHOP, O.D.
Entity Type:Organization
Organization Name:AMY E. BISHOP, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:940-937-2015
Mailing Address - Street 1:125 AVENUE B NW
Mailing Address - Street 2:PO BOX 256
Mailing Address - City:CHILDRESS
Mailing Address - State:TX
Mailing Address - Zip Code:79201-4513
Mailing Address - Country:US
Mailing Address - Phone:940-937-2015
Mailing Address - Fax:940-937-6889
Practice Address - Street 1:125 AVENUE B NW
Practice Address - Street 2:
Practice Address - City:CHILDRESS
Practice Address - State:TX
Practice Address - Zip Code:79201-4513
Practice Address - Country:US
Practice Address - Phone:940-937-2015
Practice Address - Fax:940-937-6889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4950TG332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1004840001Medicare NSC