Provider Demographics
NPI:1467625806
Name:ELSTEN EYECARE ASSOCIATES
Entity Type:Organization
Organization Name:ELSTEN EYECARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ELSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-463-8640
Mailing Address - Street 1:506 MARIPOSA
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-2481
Mailing Address - Country:US
Mailing Address - Phone:972-722-2243
Mailing Address - Fax:
Practice Address - Street 1:4701 LAKEVIEW PKWY
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-4037
Practice Address - Country:US
Practice Address - Phone:972-463-8640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5901TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty