Provider Demographics
NPI:1750581864
Name:PLANO EYE ASSOCIATES PC
Entity type:Organization
Organization Name:PLANO EYE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTLEBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-985-1412
Mailing Address - Street 1:5900 COIT RD
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-5959
Mailing Address - Country:US
Mailing Address - Phone:972-985-1412
Mailing Address - Fax:972-964-5758
Practice Address - Street 1:5900 COIT RD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-5959
Practice Address - Country:US
Practice Address - Phone:972-985-1412
Practice Address - Fax:972-964-5758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3161TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093192502Medicaid
TX5181590001Medicare NSC
TX093192502Medicaid