Provider Demographics
NPI:1265240931
Name:CROSS SORIANO OPTOMETRY PARTNERSHIP
Entity type:Organization
Organization Name:CROSS SORIANO OPTOMETRY PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATT ANTHONY
Authorized Official - Middle Name:MACAYAN
Authorized Official - Last Name:SORIANO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:224-623-2846
Mailing Address - Street 1:5420 HUFFINES BLVD APT 6308
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-5638
Mailing Address - Country:US
Mailing Address - Phone:224-623-2846
Mailing Address - Fax:
Practice Address - Street 1:109 CARROLL ST STE 111
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2068
Practice Address - Country:US
Practice Address - Phone:817-646-3449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty