1609072628 NPI number — TRICON EYE CARE CENTER, PA

Table of content: (NPI 1609072628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609072628 NPI number — TRICON EYE CARE CENTER, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRICON EYE CARE CENTER, PA
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:
1609072628
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6300 STONEWOOD DR
Provider Second Line Business Mailing Address:
304
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75024-5280
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-467-8100
Provider Business Mailing Address Fax Number:
469-467-4556

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6300 STONEWOOD DR
Provider Second Line Business Practice Location Address:
304
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75024-5280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-467-8100
Provider Business Practice Location Address Fax Number:
469-467-4556
Provider Enumeration Date:
06/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VU
Authorized Official First Name:
THEM
Authorized Official Middle Name:
LE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
469-467-8100

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  L7916 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 5552704 . This is a "FIREST HEALTH PROVIDER #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8R1300 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 3723044 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 5801951 . This is a "CIGNA PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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