Provider Demographics
NPI:1871828061
Name:PAULSEN, AMBER ELISE (OD)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:ELISE
Last Name:PAULSEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7638 STONEBROOK PKWY
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-1003
Mailing Address - Country:US
Mailing Address - Phone:972-712-1010
Mailing Address - Fax:972-712-1011
Practice Address - Street 1:7638 STONEBROOK PKWY
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-1003
Practice Address - Country:US
Practice Address - Phone:972-712-1010
Practice Address - Fax:972-712-1011
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7453TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82954QOtherBCBS ID
TX00E41YOtherGROUP PTAN
TX1902852346OtherGROUP NPI
TXDO9312OtherRAILROAD MEDICARE PTAN
TX00E41YOtherGROUP PTAN
TXP00812490Medicare PIN
TXTXB121808Medicare UPIN