Provider Demographics
NPI:1598010977
Name:HP PURE VISION EYE CARE PLLC
Entity Type:Organization
Organization Name:HP PURE VISION EYE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MYCHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-704-4010
Mailing Address - Street 1:2815 AZLE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76106-5106
Mailing Address - Country:US
Mailing Address - Phone:817-704-4010
Mailing Address - Fax:
Practice Address - Street 1:2815 AZLE AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76106-5106
Practice Address - Country:US
Practice Address - Phone:817-704-4010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HP PURE VISION EYE CARE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-20
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7142TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty