Provider Demographics
NPI:1588866909
Name:LAYTON, JOE (ABOC NCLC)
Entity type:Individual
Prefix:MR
First Name:JOE
Middle Name:
Last Name:LAYTON
Suffix:
Gender:M
Credentials:ABOC NCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4906 S STAPLES ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-3802
Mailing Address - Country:US
Mailing Address - Phone:361-991-7800
Mailing Address - Fax:
Practice Address - Street 1:4906 S STAPLES ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-3802
Practice Address - Country:US
Practice Address - Phone:361-991-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXCPOO485156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician