Provider Demographics
NPI:1891969929
Name:CARROLLTON VISION ASSOCIATES
Entity Type:Organization
Organization Name:CARROLLTON VISION ASSOCIATES
Other - Org Name:1ST EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:B
Authorized Official - Last Name:STILES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-416-1270
Mailing Address - Street 1:2810 E TRINITY MILLS RD
Mailing Address - Street 2:SUITE 173
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-2545
Mailing Address - Country:US
Mailing Address - Phone:972-416-1270
Mailing Address - Fax:972-416-4839
Practice Address - Street 1:2810 E TRINITY MILLS RD
Practice Address - Street 2:SUITE 173
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-2545
Practice Address - Country:US
Practice Address - Phone:972-416-1270
Practice Address - Fax:972-416-4839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3226TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E11GMedicare PIN