Provider Demographics
NPI:1588840292
Name:LAS COLINAS VISION CENTER, INC
Entity type:Organization
Organization Name:LAS COLINAS VISION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-717-4040
Mailing Address - Street 1:4030 N MACARTHUR BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-6425
Mailing Address - Country:US
Mailing Address - Phone:972-717-4040
Mailing Address - Fax:972-650-1796
Practice Address - Street 1:4030 N MACARTHUR BLVD STE 208
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-6425
Practice Address - Country:US
Practice Address - Phone:972-717-4040
Practice Address - Fax:972-650-1796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2928TG152W00000X, 152WC0802X
TX6272TG152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00391YMedicare PIN
TXY29194Medicare UPIN