Provider Demographics
NPI:1952655649
Name:DORECK VISION, LLC
Entity Type:Organization
Organization Name:DORECK VISION, LLC
Other - Org Name:WILLIS FAMILY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:G
Authorized Official - Last Name:DORECK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:936-856-9400
Mailing Address - Street 1:12709 INTERSTATE 45 N
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77318-7023
Mailing Address - Country:US
Mailing Address - Phone:936-856-9400
Mailing Address - Fax:936-856-9439
Practice Address - Street 1:12709 INTERSTATE 45 N
Practice Address - Street 2:SUITE 500
Practice Address - City:WILLIS
Practice Address - State:TX
Practice Address - Zip Code:77318-7023
Practice Address - Country:US
Practice Address - Phone:936-856-9400
Practice Address - Fax:936-856-9439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-01
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7372TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX268625Medicare PIN