Provider Demographics
NPI:1053830695
Name:EYEMAX FAMILY VISION PLLC
Entity Type:Organization
Organization Name:EYEMAX FAMILY VISION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:MALIK
Authorized Official - Middle Name:
Authorized Official - Last Name:MAMDANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-850-8001
Mailing Address - Street 1:10414 CRESTOVER DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-5215
Mailing Address - Country:US
Mailing Address - Phone:972-850-8001
Mailing Address - Fax:
Practice Address - Street 1:1515 N TOWN EAST BLVD STE 523
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4198
Practice Address - Country:US
Practice Address - Phone:972-638-8600
Practice Address - Fax:972-372-0240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-14
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6162-TG152W00000X, 152WC0802X
156FC0800X, 156FC0801X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact LensGroup - Multi-Specialty
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty