Provider Demographics
NPI:1851636989
Name:TROPHY CLUB VISION CARE LLP
Entity Type:Organization
Organization Name:TROPHY CLUB VISION CARE LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:NOEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:682-831-0999
Mailing Address - Street 1:2001 E HIGHWAY 114 STE 180
Mailing Address - Street 2:
Mailing Address - City:TROPHY CLUB
Mailing Address - State:TX
Mailing Address - Zip Code:76262-6656
Mailing Address - Country:US
Mailing Address - Phone:682-831-0999
Mailing Address - Fax:682-831-0998
Practice Address - Street 1:2001 E HIGHWAY 114 STE 180
Practice Address - Street 2:
Practice Address - City:TROPHY CLUB
Practice Address - State:TX
Practice Address - Zip Code:76262-6656
Practice Address - Country:US
Practice Address - Phone:682-831-0999
Practice Address - Fax:682-831-0998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX005588TG152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU72766Medicare UPIN
TX8J9844Medicare PIN