Provider Demographics
NPI:1801226238
Name:JENNIFER CATUNCAN OD PLLC
Entity Type:Organization
Organization Name:JENNIFER CATUNCAN OD PLLC
Other - Org Name:FIRST EYE CARE BEDFORD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CATUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-284-2964
Mailing Address - Street 1:2400 AIRPORT FWY
Mailing Address - Street 2:STE 140
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6098
Mailing Address - Country:US
Mailing Address - Phone:817-284-2964
Mailing Address - Fax:817-283-2760
Practice Address - Street 1:2400 AIRPORT FWY
Practice Address - Street 2:STE 140
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6098
Practice Address - Country:US
Practice Address - Phone:817-284-2964
Practice Address - Fax:817-283-2760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-21
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7057 TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX337560Medicare PIN
TX342343YYTPMedicare PIN