Provider Demographics
NPI:1790968428
Name:FLOYD-ROSENBERG OPTOMETRISTS PA
Entity Type:Organization
Organization Name:FLOYD-ROSENBERG OPTOMETRISTS PA
Other - Org Name:SHARP EYES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-315-5202
Mailing Address - Street 1:2410 S STEMMONS FWY
Mailing Address - Street 2:STE. E
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-8777
Mailing Address - Country:US
Mailing Address - Phone:972-315-5202
Mailing Address - Fax:972-315-3083
Practice Address - Street 1:2410 S STEMMONS FWY
Practice Address - Street 2:STE. E
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-8777
Practice Address - Country:US
Practice Address - Phone:972-315-5202
Practice Address - Fax:972-315-3083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02832T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00764ZMedicare PIN