Provider Demographics
NPI:1265031918
Name:MOUNT VERNON EYE CARE & EYEWEAR GALLERY PLLC
Entity Type:Organization
Organization Name:MOUNT VERNON EYE CARE & EYEWEAR GALLERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HALEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:PURYEAR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:312-810-0764
Mailing Address - Street 1:PO BOX 595
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:75457-0595
Mailing Address - Country:US
Mailing Address - Phone:903-402-2707
Mailing Address - Fax:903-402-1770
Practice Address - Street 1:508 TEXAS HIGHWAY 37 S
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:TX
Practice Address - Zip Code:75457-6550
Practice Address - Country:US
Practice Address - Phone:903-402-2707
Practice Address - Fax:903-402-1770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-23
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty