1942425855 NPI number — BALL FAMILY VISION CENTER

Table of content: (NPI 1942425855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942425855 NPI number — BALL FAMILY VISION CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BALL FAMILY VISION CENTER
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:
6
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:
1942425855
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 COUNTRY CLUB RD STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARGYLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76226-2358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-464-2020
Provider Business Mailing Address Fax Number:
940-464-2021

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 COUNTRY CLUB RD STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARGYLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-464-2020
Provider Business Practice Location Address Fax Number:
940-464-2021
Provider Enumeration Date:
04/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHIH
Authorized Official First Name:
ELAINE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
940-464-2020

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  6059T , 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: 00140S . This is a "MEDICARE PTIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0078FA . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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