Provider Demographics
NPI:1235868423
Name:EYES ON PRESTON PARK PLLC
Entity Type:Organization
Organization Name:EYES ON PRESTON PARK PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:THEIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-519-0006
Mailing Address - Street 1:1900 PRESTON RD STE 265
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5203
Mailing Address - Country:US
Mailing Address - Phone:972-519-0006
Mailing Address - Fax:972-519-0069
Practice Address - Street 1:1900 PRESTON RD STE 265
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5203
Practice Address - Country:US
Practice Address - Phone:972-519-0006
Practice Address - Fax:972-519-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty