Provider Demographics
NPI:1912093600
Name:EYECARE ASSOCIATES OF TEXAS, PA
Entity Type:Organization
Organization Name:EYECARE ASSOCIATES OF TEXAS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:MEDFORD
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-296-2929
Mailing Address - Street 1:634 UPTOWN BLVD
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-3529
Mailing Address - Country:US
Mailing Address - Phone:972-637-1300
Mailing Address - Fax:866-353-7586
Practice Address - Street 1:507 W CROSSLAND BLVD
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-6642
Practice Address - Country:US
Practice Address - Phone:972-642-2121
Practice Address - Fax:972-642-9997
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYECARE ASSOCIATES OF TEXAS, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-04
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0350890003Medicare NSC