Provider Demographics
NPI:1760804868
Name:OPTIQUE INC
Entity Type:Organization
Organization Name:OPTIQUE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:EVERETT
Authorized Official - Last Name:ORM
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:214-252-1800
Mailing Address - Street 1:3636 MCKINNEY AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-1422
Mailing Address - Country:US
Mailing Address - Phone:214-252-1800
Mailing Address - Fax:214-252-1801
Practice Address - Street 1:3636 MCKINNEY AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-1422
Practice Address - Country:US
Practice Address - Phone:214-252-1800
Practice Address - Fax:214-252-1801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2366T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty