Provider Demographics
NPI:1891181202
Name:NE TEXAS EYE ASSOCIATES PLLC
Entity Type:Organization
Organization Name:NE TEXAS EYE ASSOCIATES PLLC
Other - Org Name:1ST EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-540-2015
Mailing Address - Street 1:2301 ELDORADO PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-4362
Mailing Address - Country:US
Mailing Address - Phone:972-540-2015
Mailing Address - Fax:
Practice Address - Street 1:2301 ELDORADO PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-4362
Practice Address - Country:US
Practice Address - Phone:972-540-2015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5621TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty