Provider Demographics
NPI:1598101479
Name:RICHARDSON VISION CENTER
Entity Type:Organization
Organization Name:RICHARDSON VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:GERALD
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:214-293-1935
Mailing Address - Street 1:1110 WEST SHORE DR.
Mailing Address - Street 2:SUITE 250
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080
Mailing Address - Country:US
Mailing Address - Phone:214-293-1935
Mailing Address - Fax:
Practice Address - Street 1:1110 W SHORE DR
Practice Address - Street 2:250
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4054
Practice Address - Country:US
Practice Address - Phone:214-293-1935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty