Provider Demographics
NPI:1427191741
Name:CONWAL CORP
Entity Type:Organization
Organization Name:CONWAL CORP
Other - Org Name:DUNCANVILLE OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:O
Authorized Official - Last Name:HACKFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-298-5800
Mailing Address - Street 1:502 TOWNE PL
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-4929
Mailing Address - Country:US
Mailing Address - Phone:972-298-5800
Mailing Address - Fax:
Practice Address - Street 1:533 W WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4515
Practice Address - Country:US
Practice Address - Phone:972-298-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0865750-01Medicaid
TX0865750-01Medicaid