Provider Demographics
NPI:1265563472
Name:CLEARVIEW LASER VISION CENTER ASSOCIATES, L.L.P.
Entity type:Organization
Organization Name:CLEARVIEW LASER VISION CENTER ASSOCIATES, L.L.P.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:WALLACE
Authorized Official - Middle Name:
Authorized Official - Last Name:RYNE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-329-2700
Mailing Address - Street 1:1980 E STATE HIGHWAY 114
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6510
Mailing Address - Country:US
Mailing Address - Phone:817-329-2700
Mailing Address - Fax:
Practice Address - Street 1:1980 E STATE HIGHWAY 114
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6510
Practice Address - Country:US
Practice Address - Phone:817-329-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5968410001Medicare NSC
TX00815XMedicare PIN