Provider Demographics
NPI:1376318212
Name:ROANOKE FAMILY EYECARE CENTER, PLLC
Entity Type:Organization
Organization Name:ROANOKE FAMILY EYECARE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARJINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-757-9271
Mailing Address - Street 1:1485 PRIMROSE PL
Mailing Address - Street 2:
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052-1813
Mailing Address - Country:US
Mailing Address - Phone:817-757-9271
Mailing Address - Fax:
Practice Address - Street 1:1228 N HIGHWAY 377
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262-9122
Practice Address - Country:US
Practice Address - Phone:682-831-9335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-21
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty