Provider Demographics
NPI:1083144661
Name:CORSICANA FIRST EYECARE PLLC
Entity Type:Organization
Organization Name:CORSICANA FIRST EYECARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE SPECIALISTS
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-960-2020
Mailing Address - Street 1:6446 LBJ FWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-6407
Mailing Address - Country:US
Mailing Address - Phone:972-960-2020
Mailing Address - Fax:972-960-2063
Practice Address - Street 1:400 N 15TH ST
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-4514
Practice Address - Country:US
Practice Address - Phone:903-872-2561
Practice Address - Fax:903-872-5273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-15
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty