Provider Demographics
NPI:1114626777
Name:LEGACY WEST TEXAS EYE CARE
Entity Type:Organization
Organization Name:LEGACY WEST TEXAS EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-368-8247
Mailing Address - Street 1:7500 WINDROSE AVE UNIT B180
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-0163
Mailing Address - Country:US
Mailing Address - Phone:469-931-2138
Mailing Address - Fax:469-931-2152
Practice Address - Street 1:7500 WINDROSE AVE UNIT B180
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-0163
Practice Address - Country:US
Practice Address - Phone:469-931-2138
Practice Address - Fax:469-931-2152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty