Provider Demographics
NPI:1972731081
Name:DECKER VISION GROUP
Entity Type:Organization
Organization Name:DECKER VISION GROUP
Other - Org Name:DR. LARRY W. DECKER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:903-577-8946
Mailing Address - Street 1:2311 S JEFFERSON AVE
Mailing Address - Street 2:SUITE 20/20
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-6011
Mailing Address - Country:US
Mailing Address - Phone:903-577-8946
Mailing Address - Fax:903-577-8951
Practice Address - Street 1:2311 S JEFFERSON AVE
Practice Address - Street 2:SUITE 20/20
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-6011
Practice Address - Country:US
Practice Address - Phone:903-577-8946
Practice Address - Fax:903-577-8951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-26
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4731TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019181901Medicaid
TX00E03WMedicare PIN