Provider Demographics
NPI:1427357763
Name:SEAGRAVES, CANDACE (OD)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:SEAGRAVES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 HERITAGE TRACE PKWY
Mailing Address - Street 2:STE. 400
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-5312
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4160 HERITAGE TRACE PKWY
Practice Address - Street 2:STE. 400
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5312
Practice Address - Country:US
Practice Address - Phone:817-741-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7330TG152W00000X
OH5820/T2744152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist