Provider Demographics
NPI:1639612302
Name:PARK WAY EYE CARE, PLLC
Entity Type:Organization
Organization Name:PARK WAY EYE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPEUTIC OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:NGUYEN
Authorized Official - Last Name:WEI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-754-5859
Mailing Address - Street 1:2200 DALLAS PARKWAY
Mailing Address - Street 2:SUITE 330
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093
Mailing Address - Country:US
Mailing Address - Phone:972-754-5859
Mailing Address - Fax:972-378-0964
Practice Address - Street 1:2200 DALLAS PARKWAY
Practice Address - Street 2:SUITE 330
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093
Practice Address - Country:US
Practice Address - Phone:972-754-5859
Practice Address - Fax:972-378-0964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8395TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX369080ZJHZMedicare UPIN