Provider Demographics
NPI:1679625941
Name:ALLIED EYE ASSOCIATES PC
Entity Type:Organization
Organization Name:ALLIED EYE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-335-1395
Mailing Address - Street 1:4405 GIOVANNI DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3879
Mailing Address - Country:US
Mailing Address - Phone:972-335-1395
Mailing Address - Fax:972-335-1405
Practice Address - Street 1:13131 PRESTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-5203
Practice Address - Country:US
Practice Address - Phone:972-404-1114
Practice Address - Fax:972-404-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160852301Medicaid
TX0066JYOtherBCBS GROUP ID
TX00475VMedicare PIN