Provider Demographics
NPI:1235231432
Name:EAST DALLAS FAMILY EYE CARE PA
Entity Type:Organization
Organization Name:EAST DALLAS FAMILY EYE CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:MR
Authorized Official - First Name:ANAND
Authorized Official - Middle Name:S
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:214-391-1119
Mailing Address - Street 1:8202 ELAM RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75217-4509
Mailing Address - Country:US
Mailing Address - Phone:214-391-1119
Mailing Address - Fax:214-391-6444
Practice Address - Street 1:8202 ELAM RD
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-4509
Practice Address - Country:US
Practice Address - Phone:214-391-1119
Practice Address - Fax:214-391-6444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6306TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173178801Medicaid
TX00198YMedicare PIN
TX5647200001Medicare NSC