Provider Demographics
NPI:1922204858
Name:PLAZA OPTICAL INC.
Entity Type:Organization
Organization Name:PLAZA OPTICAL INC.
Other - Org Name:HURST OPTICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:BERK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-750-5793
Mailing Address - Street 1:8309 PRESTON RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-5510
Mailing Address - Country:US
Mailing Address - Phone:214-750-5793
Mailing Address - Fax:214-750-6668
Practice Address - Street 1:945 MELBOURNE RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-4632
Practice Address - Country:US
Practice Address - Phone:817-284-9198
Practice Address - Fax:817-284-2443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDR2632332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX505218Medicare ID - Type UnspecifiedBLUE CROSS BLUE SHIELD