Provider Demographics
NPI:1437447562
Name:VILLAFANE, OSCAR (OD)
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:
Last Name:VILLAFANE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9925 WILD GINGER DR
Mailing Address - Street 2:MCKINNEY
Mailing Address - City:TEXAS
Mailing Address - State:TX
Mailing Address - Zip Code:75072
Mailing Address - Country:US
Mailing Address - Phone:352-317-4291
Mailing Address - Fax:
Practice Address - Street 1:LONG VISION CENTER
Practice Address - Street 2:2203 N HERITAGE PKWY
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092
Practice Address - Country:US
Practice Address - Phone:903-892-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7813TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1124091-04Medicaid
TX287519701Medicaid
TXTXB135967Medicare UPIN
TX287519701Medicaid