Provider Demographics
NPI:1003991878
Name:EYECARE ASSOCIATES OF TEXAS, PA
Entity Type:Organization
Organization Name:EYECARE ASSOCIATES OF TEXAS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-296-2929
Mailing Address - Street 1:907 S MAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-2385
Mailing Address - Country:US
Mailing Address - Phone:972-296-2929
Mailing Address - Fax:972-709-4099
Practice Address - Street 1:907 S MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-2385
Practice Address - Country:US
Practice Address - Phone:972-296-2929
Practice Address - Fax:972-709-4099
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYECARE ASSOCIATES OF TEXAS, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-27
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0350890002Medicare NSC