Jerry D Redwine

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

2296T Issued in TX

Legal business name

JERRY D REDWINE

Practice address

111 E 3Rd St
Muleshoe, TX 79347-3801

Phone

(806) 272-4705

Fax

(806) 272-3824

NPI assigned

Jan 9, 2008

Last updated

Jan 10, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Donna Jean Redwine

Title

Office Manager

Phone

(806) 272-4705

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1199836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199923200000",
    "number": "1457537383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1011",
            "city": "MULESHOE",
            "state": "TX",
            "postal_code": "793471011",
            "telephone_number": "806-272-4705",
            "fax_number": "806-272-3824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E 3RD ST",
            "city": "MULESHOE",
            "state": "TX",
            "postal_code": "793473801",
            "telephone_number": "806-272-4705",
            "fax_number": "806-272-3824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERRY D REDWINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-09",
        "last_updated": "2008-01-10",
        "status": "A",
        "authorized_official_last_name": "REDWINE",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "806-272-4705",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "TX",
            "license": "2296T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Eyewear Supplier in Muleshoe, TX
• Providers in Muleshoe, TX by specialty
• Eyewear Supplier in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2008; 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.