Provider Demographics
NPI:1447810080
Name:ERVIN, JULIE (OD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:ERVIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 RACE ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76111-4104
Mailing Address - Country:US
Mailing Address - Phone:214-763-3409
Mailing Address - Fax:817-238-3511
Practice Address - Street 1:2902 RACE ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76111-4104
Practice Address - Country:US
Practice Address - Phone:682-747-6319
Practice Address - Fax:817-238-3511
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9698TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist