Provider Demographics
NPI:1245539220
Name:PROFESSIONAL OPTOMETRISTS, P.C.
Entity type:Organization
Organization Name:PROFESSIONAL OPTOMETRISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:W
Authorized Official - Last Name:CAVETT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:325-643-1826
Mailing Address - Street 1:2910 MARKET LOOP
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-1855
Mailing Address - Country:US
Mailing Address - Phone:254-778-9100
Mailing Address - Fax:254-778-3297
Practice Address - Street 1:2910 MARKET LOOP
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1855
Practice Address - Country:US
Practice Address - Phone:254-778-9100
Practice Address - Fax:254-778-3297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty