Provider Demographics
NPI:1396766309
Name:OPTIMUM EYECARE, INC.
Entity type:Organization
Organization Name:OPTIMUM EYECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NGA
Authorized Official - Middle Name:THI
Authorized Official - Last Name:VU-TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-419-8871
Mailing Address - Street 1:6851 MATLOCK ROAD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-3519
Mailing Address - Country:US
Mailing Address - Phone:817-419-8871
Mailing Address - Fax:
Practice Address - Street 1:6851 MATLOCK ROAD
Practice Address - Street 2:SUITE 111
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-3519
Practice Address - Country:US
Practice Address - Phone:817-419-8871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3788747-02Medicaid