Provider Demographics
NPI:1598343121
Name:JOHN L BASS OD PC
Entity Type:Organization
Organization Name:JOHN L BASS OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-312-9771
Mailing Address - Street 1:1636 PLEASANT RUN
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-5381
Mailing Address - Country:US
Mailing Address - Phone:817-312-9771
Mailing Address - Fax:
Practice Address - Street 1:2702 S HULEN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-5590
Practice Address - Country:US
Practice Address - Phone:817-312-9771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty