Provider Demographics
NPI:1457419749
Name:FULL OF VISION
Entity Type:Organization
Organization Name:FULL OF VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DORA
Authorized Official - Middle Name:E
Authorized Official - Last Name:TILLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-868-7923
Mailing Address - Street 1:195 E ROUND GROVE RD APT 1828
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3844
Mailing Address - Country:US
Mailing Address - Phone:214-868-7923
Mailing Address - Fax:
Practice Address - Street 1:195 E ROUND GROVE RD APT 1828
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3844
Practice Address - Country:US
Practice Address - Phone:214-868-7923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherHCS WAVIER