Provider Demographics
NPI:1740369487
Name:ESSENTIAL EYECARE, INC.
Entity type:Organization
Organization Name:ESSENTIAL EYECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANTHA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:NEPHEW
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-296-0100
Mailing Address - Street 1:PO BOX 1923
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75123-1923
Mailing Address - Country:US
Mailing Address - Phone:972-296-0100
Mailing Address - Fax:972-296-5719
Practice Address - Street 1:2900 W WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3535
Practice Address - Country:US
Practice Address - Phone:972-296-0100
Practice Address - Fax:972-296-5719
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ESSENTIAL EYECARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-03
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6671T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty