Provider Demographics
NPI:1952847436
Name:CARLENS LUXURY OPTICAL LLC
Entity Type:Organization
Organization Name:CARLENS LUXURY OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CARMONA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-824-0325
Mailing Address - Street 1:8020 PARK LN
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-6055
Mailing Address - Country:US
Mailing Address - Phone:972-824-4204
Mailing Address - Fax:
Practice Address - Street 1:8020 PARK LN
Practice Address - Street 2:SUITE 110
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-6055
Practice Address - Country:US
Practice Address - Phone:972-824-4204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX223731156FC0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherEYETOPIA