Provider Demographics
NPI:1407269137
Name:COLEMAN EYECARE PLLC
Entity Type:Organization
Organization Name:COLEMAN EYECARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:214-704-4702
Mailing Address - Street 1:15220 MONTFORT RD
Mailing Address - Street 2:SUITE 1001
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-6401
Mailing Address - Country:US
Mailing Address - Phone:972-308-0022
Mailing Address - Fax:972-233-9317
Practice Address - Street 1:15220 MONTFORT RD
Practice Address - Street 2:SUITE 1001
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-6401
Practice Address - Country:US
Practice Address - Phone:972-308-0022
Practice Address - Fax:972-233-9317
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLEMAN EYECARE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-10
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7320TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty