1720479306 NPI number — GENEYE INC.

Table of content: (NPI 1720479306)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720479306 NPI number — GENEYE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENEYE 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:
DUNCANVILLE EYE ASSOCIATION AND/OR DUNCANVILLE OPTICAL
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:
1720479306
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
535 W WHEATLAND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUNCANVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75116-4515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-298-7249
Provider Business Mailing Address Fax Number:
972-298-6740

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
535 W WHEATLAND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNCANVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75116-4515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-298-7249
Provider Business Practice Location Address Fax Number:
972-298-6740
Provider Enumeration Date:
02/18/2015

Additional Information

Authorized Official

Authorized Official Last Name:
YOTHERS
Authorized Official First Name:
TRACEY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DR. TRACEY L. YOTHERS O.D.
Authorized Official Telephone Number:
972-298-7249

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  5168TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152WC0802X , with the licence number: 5168TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WL0500X , with the licence number: 5168TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WP0200X , with the licence number: 5168TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WV0400X , with the licence number: 5168TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 156FX1800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 364924601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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