Provider Demographics
NPI:1225153869
Name:RICHARDSON VISION & CONTACT LENS CLINIC, PC
Entity Type:Organization
Organization Name:RICHARDSON VISION & CONTACT LENS CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-231-3439
Mailing Address - Street 1:1120 W CAMPBELL RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2977
Mailing Address - Country:US
Mailing Address - Phone:972-231-3439
Mailing Address - Fax:972-231-0260
Practice Address - Street 1:1120 W CAMPBELL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2977
Practice Address - Country:US
Practice Address - Phone:972-231-3439
Practice Address - Fax:972-231-0260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2134TG332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1003150001Medicare NSC
TX0A6095Medicare PIN