Provider Demographics
NPI:1891320826
Name:DALLAS EYE AND EAR OPTICAL, PLLC
Entity Type:Organization
Organization Name:DALLAS EYE AND EAR OPTICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-987-2875
Mailing Address - Street 1:1703 N BECKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-1007
Mailing Address - Country:US
Mailing Address - Phone:214-987-2875
Mailing Address - Fax:
Practice Address - Street 1:1703 N BECKLEY AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1007
Practice Address - Country:US
Practice Address - Phone:214-987-2875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LINDA L BURK MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-10
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty