Provider Demographics
NPI:1851687644
Name:ECSC II, PA
Entity Type:Organization
Organization Name:ECSC II, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:K
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-361-1443
Mailing Address - Street 1:5421 LA SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4107
Mailing Address - Country:US
Mailing Address - Phone:214-361-1433
Mailing Address - Fax:214-368-8365
Practice Address - Street 1:2800 S HULEN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-1504
Practice Address - Country:US
Practice Address - Phone:214-361-1443
Practice Address - Fax:214-368-8365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00A64WMedicare PIN