Provider Demographics
NPI:1114110970
Name:MESQUITE FAMILY OPTOMETRY
Entity Type:Organization
Organization Name:MESQUITE FAMILY OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:K
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-288-2520
Mailing Address - Street 1:820 E CARTWRIGHT RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-6000
Mailing Address - Country:US
Mailing Address - Phone:972-288-2520
Mailing Address - Fax:972-288-2236
Practice Address - Street 1:820 E CARTWRIGHT RD
Practice Address - Street 2:SUITE 150
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-6000
Practice Address - Country:US
Practice Address - Phone:972-288-2520
Practice Address - Fax:972-288-2236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty