Provider Demographics
NPI:1538686779
Name:MRS VENTURES LLC
Entity Type:Organization
Organization Name:MRS VENTURES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SRISHTI
Authorized Official - Middle Name:
Authorized Official - Last Name:ATTRI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-506-7162
Mailing Address - Street 1:3828 SHIVER RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-8688
Mailing Address - Country:US
Mailing Address - Phone:817-741-1073
Mailing Address - Fax:817-741-1079
Practice Address - Street 1:9549 SAGE MEADOW TRL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-8595
Practice Address - Country:US
Practice Address - Phone:817-741-1073
Practice Address - Fax:817-741-1079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9328TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA21546OtherEYEMED
FLDQMEAOtherBCBS
FL66657-003OtherDAVIS VISION
TX3911091Medicaid