1689782724 NPI number — DOUBLE VISION

Table of content: (NPI 1689782724)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689782724 NPI number — DOUBLE VISION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOUBLE VISION
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:
THE LEGENDS AT HILLSBORO
Provider Other Organization Name Type Code:
3
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:
1689782724
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9112 CAMP BOWIE W # 222
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76116-6099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-249-2300
Provider Business Mailing Address Fax Number:
817-249-4300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 OUTLET DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILLSBORO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76645-2752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-582-0030
Provider Business Practice Location Address Fax Number:
254-580-1608
Provider Enumeration Date:
08/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
SENIOR ASSET MANAGER
Authorized Official Telephone Number:
817-249-2300

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  116891 , 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)





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