Provider Demographics
NPI:1598249070
Name:TSO ROCKWALL LLC
Entity Type:Organization
Organization Name:TSO ROCKWALL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REID
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:432-230-5615
Mailing Address - Street 1:3301 N GOLIAD ST STE 109
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-7194
Mailing Address - Country:US
Mailing Address - Phone:432-230-5615
Mailing Address - Fax:
Practice Address - Street 1:3301 N GOLIAD ST STE 109
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-7194
Practice Address - Country:US
Practice Address - Phone:432-230-5615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-20
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty