Provider Demographics
NPI:1659478766
Name:FLOWER MOUND EYECARE ASSOCIATES
Entity Type:Organization
Organization Name:FLOWER MOUND EYECARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-724-3030
Mailing Address - Street 1:2321 CROSS TIMBERS RD
Mailing Address - Street 2:STE 425
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2618
Mailing Address - Country:US
Mailing Address - Phone:972-724-3030
Mailing Address - Fax:972-691-3721
Practice Address - Street 1:2321 CROSS TIMBERS RD
Practice Address - Street 2:STE 425
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2618
Practice Address - Country:US
Practice Address - Phone:972-724-3030
Practice Address - Fax:972-691-3721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5468TG152W00000X
TX5408TG152W00000X
TX6853TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0005FDOtherBLUE CROSS BLUE SHIELD
TX00985NMedicare ID - Type Unspecified