Provider Demographics
NPI:1518545813
Name:I&M OPTICS LLC
Entity Type:Organization
Organization Name:I&M OPTICS LLC
Other - Org Name:MY EYELAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-843-1393
Mailing Address - Street 1:6415 ATHENEE LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0369
Mailing Address - Country:US
Mailing Address - Phone:347-610-6818
Mailing Address - Fax:561-828-8367
Practice Address - Street 1:6415 ATHENEE LN
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-0369
Practice Address - Country:US
Practice Address - Phone:347-610-6818
Practice Address - Fax:561-828-8367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-30
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty