Provider Demographics
NPI:1336382746
Name:SWISS EYE CARE PLLC
Entity Type:Organization
Organization Name:SWISS EYE CARE PLLC
Other - Org Name:SWISS EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANG
Authorized Official - Middle Name:
Authorized Official - Last Name:AN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-242-1658
Mailing Address - Street 1:2625 OLD DENTON RD
Mailing Address - Street 2:SUITE 548
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-5125
Mailing Address - Country:US
Mailing Address - Phone:972-242-1652
Mailing Address - Fax:972-242-1694
Practice Address - Street 1:2625 OLD DENTON RD
Practice Address - Street 2:SUITE 548
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-5125
Practice Address - Country:US
Practice Address - Phone:972-242-1652
Practice Address - Fax:972-242-1694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-14
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7039152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A5280Medicare PIN