Provider Demographics
NPI:1043485451
Name:ALAN H UPCHURCH OD PA
Entity Type:Organization
Organization Name:ALAN H UPCHURCH OD PA
Other - Org Name:ALAN H UPCHURCH O D PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:UPCHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-542-0331
Mailing Address - Street 1:3705 ELDORADO PKWY
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-4229
Mailing Address - Country:US
Mailing Address - Phone:972-542-0331
Mailing Address - Fax:972-548-1102
Practice Address - Street 1:3705 W ELDORADO PKWY
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-4229
Practice Address - Country:US
Practice Address - Phone:972-542-0331
Practice Address - Fax:972-548-1102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3701-TG152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT16373Medicare UPIN
TXDU3488Medicare PIN
TXTXB152140Medicare PIN
TX0191800001Medicare NSC