Provider Demographics
NPI:1265606693
Name:EYE CLINIC, P.A.
Entity type:Organization
Organization Name:EYE CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-335-1395
Mailing Address - Street 1:811 N CENTRAL EXPY
Mailing Address - Street 2:STE 1005
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-8815
Mailing Address - Country:US
Mailing Address - Phone:972-633-5000
Mailing Address - Fax:972-423-0454
Practice Address - Street 1:811 N CENTRAL EXPY
Practice Address - Street 2:STE 1005
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-8815
Practice Address - Country:US
Practice Address - Phone:972-633-5000
Practice Address - Fax:972-423-0454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6199490001Medicare NSC
TX00Z239Medicare PIN