1780641076 NPI number — DR. JUDY RATTAN O.D.

Table of content: DR. JUDY RATTAN O.D. (NPI 1780641076)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780641076 NPI number — DR. JUDY RATTAN O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RATTAN
Provider First Name:
JUDY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780641076
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2633 GALLANT FOX DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCHERTZ
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78108-2318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-479-4929
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
221 3RD ST W
Provider Second Line Business Practice Location Address:
359 AMDS/SGPE
Provider Business Practice Location Address City Name:
JBSA RANDOLPH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78150-4800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-652-5526
Provider Business Practice Location Address Fax Number:
210-652-6348
Provider Enumeration Date:
04/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  3499 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)