Provider Demographics
NPI:1396399721
Name:LIBRA OPTOMETRY PA
Entity Type:Organization
Organization Name:LIBRA OPTOMETRY PA
Other - Org Name:V EYE P PRESTON HOLLOW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-393-3008
Mailing Address - Street 1:7859 WALNUT HILL LN STE 185
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-5605
Mailing Address - Country:US
Mailing Address - Phone:214-378-2020
Mailing Address - Fax:
Practice Address - Street 1:7859 WALNUT HILL LN STE 185
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-5605
Practice Address - Country:US
Practice Address - Phone:214-378-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-24
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty