Provider Demographics
NPI:1932488863
Name:XPRESS EYECARE
Entity Type:Organization
Organization Name:XPRESS EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:EASON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:806-678-3235
Mailing Address - Street 1:16327 PRAIRIE GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015-5601
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3630 I-40 E
Practice Address - Street 2:SUITE 300
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79103-6101
Practice Address - Country:US
Practice Address - Phone:806-379-9090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4984T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046416602Medicaid
TX046416602Medicaid