Provider Demographics
NPI:1144588443
Name:ATLANTIC FAMILY EYE CARE PLLC
Entity Type:Organization
Organization Name:ATLANTIC FAMILY EYE CARE PLLC
Other - Org Name:EYES IN SIGHT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-733-6636
Mailing Address - Street 1:9191 KYSER WAY
Mailing Address - Street 2:STE #600
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034
Mailing Address - Country:US
Mailing Address - Phone:214-705-9433
Mailing Address - Fax:214-705-9318
Practice Address - Street 1:9191 KYSER WAY
Practice Address - Street 2:STE #600
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034
Practice Address - Country:US
Practice Address - Phone:214-705-9433
Practice Address - Fax:214-705-9318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7605TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty