Provider Demographics
NPI:1720423064
Name:EBENEZER EYECARE, P.L.L.C.
Entity Type:Organization
Organization Name:EBENEZER EYECARE, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:ELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-240-6747
Mailing Address - Street 1:601 W PLANO PKWY STE 141B
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-8969
Mailing Address - Country:US
Mailing Address - Phone:972-516-1400
Mailing Address - Fax:972-516-8324
Practice Address - Street 1:601 W PLANO PKWY STE 141B
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-8969
Practice Address - Country:US
Practice Address - Phone:972-516-1400
Practice Address - Fax:972-516-8324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7790TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty