NPIMap

Organization Active NPI

Bates & Harris O D Inc

Doing business as Texas State Optical of Victoria

  • Optometrist
  • Victoria, TX
National Provider Identifier
1417973280
Registry record updated Jul 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3433T Issued in TX
Legal business name
BATES & HARRIS O D INC
Doing business as
Texas State Optical of Victoria
Practice address
505 E Mockingbird LN
Victoria, TX 77904-2043
Phone
(361) 578-2904
Fax
(361) 578-7931
NPI assigned
Jul 14, 2006
Last updated
Jul 3, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Loren C Wakham, ODNPI 1275683104
Title
Owner
Phone
(361) 578-2904

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3433T TX Primary

Addresses

Primary practice location

505 E Mockingbird LN
Victoria, TX 77904-2043

Mailing address

505 E Mockingbird LN
Victoria, TX 77904-2043
Phone (361) 578-2904

Other identifiers 1

IdentifierTypeStateIssuer
019365801MedicaidTX

Other names 1

  • Texas State Optical of Victoria Doing business as

National Provider Directory

National Provider Directory

Locations

505 E Mockingbird Ln
Victoria, TX 77904
Phone (361) 578-2904

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372809600000",
    "number": "1417973280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 E MOCKINGBIRD LN",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "779042043",
            "telephone_number": "361-578-2904",
            "fax_number": "361-578-7931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 E MOCKINGBIRD LN",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "779042043",
            "telephone_number": "361-578-2904",
            "fax_number": "361-578-7931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BATES & HARRIS O D INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2013-07-03",
        "status": "A",
        "authorized_official_last_name": "WAKHAM",
        "authorized_official_first_name": "LOREN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "361-578-2904",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "3433T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019365801",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Texas State Optical of Victoria",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Victoria, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.