Provider Demographics
NPI:1366036642
Name:CEDAR HILL EYE CARE PLLC
Entity Type:Organization
Organization Name:CEDAR HILL EYE CARE PLLC
Other - Org Name:CEDAR HILL EYECARE PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:INSURANCE CORD
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ARNOLD
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:214-293-2020
Mailing Address - Street 1:818 N HIGHWAY 67 STE 104
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-2102
Mailing Address - Country:US
Mailing Address - Phone:972-293-2020
Mailing Address - Fax:972-637-9121
Practice Address - Street 1:818 N HIGHWAY 67 STE 104
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2102
Practice Address - Country:US
Practice Address - Phone:972-293-2020
Practice Address - Fax:972-637-9121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-26
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1578666012Medicaid