Provider Demographics
NPI:1942087739
Name:BEACON VISION CENTER PLLC
Entity Type:Organization
Organization Name:BEACON VISION CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURCHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-420-5090
Mailing Address - Street 1:4306 CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-3624
Mailing Address - Country:US
Mailing Address - Phone:214-420-5090
Mailing Address - Fax:214-420-5091
Practice Address - Street 1:4306 CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-3624
Practice Address - Country:US
Practice Address - Phone:214-420-5090
Practice Address - Fax:214-420-5091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty