1336185727 NPI number — EYECARE & EYEWEAR INC.

Table of content: (NPI 1336185727)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336185727 NPI number — EYECARE & EYEWEAR INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYECARE & EYEWEAR INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1336185727
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3111 UNICORN LAKE BLVD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76210-0118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-891-3937
Provider Business Mailing Address Fax Number:
940-591-8368

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3111 UNICORN LAKE BLVD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76210-0118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-891-3937
Provider Business Practice Location Address Fax Number:
940-591-8368
Provider Enumeration Date:
06/22/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TRUSTY
Authorized Official First Name:
KELBY
Authorized Official Middle Name:
ATKINS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
940-891-3937

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  03995TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 019328601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3995TG . This is a "OD LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0178390001 . This is a "MEDICARE - PALMETTO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".