Provider Demographics
NPI:1780864066
Name:MIDWAY EYE ASSOCIATES
Entity Type:Organization
Organization Name:MIDWAY EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BROUSSARD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-801-2727
Mailing Address - Street 1:3405 MIDWAY RD
Mailing Address - Street 2:SUITE 421
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8138
Mailing Address - Country:US
Mailing Address - Phone:972-801-2727
Mailing Address - Fax:972-943-3485
Practice Address - Street 1:3405 MIDWAY RD
Practice Address - Street 2:SUITE 421
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8138
Practice Address - Country:US
Practice Address - Phone:972-801-2727
Practice Address - Fax:972-943-3485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6060TG152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0081FBOtherBCBS GROUP
TX00459UMedicare PIN