MEDICARE: OPTIMEYES OPTOMETRY, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	7332TG	TX

General Provider Information

NPI Number	:	1043519556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMEYES OPTOMETRY, PLLC

Provider Business Mailing Address
First Line	:	806 S ALLEN HEIGHTS DR
Second Line	:	SUITE 300
City	:	ALLEN
State	:	TX
Zip	:	75002-1875
Country	:	US
Telephone Number	:	214-383-7600
Fax Number	:	214-383-7652

Provider Business Practice Location Address
First Line	:	806 S ALLEN HEIGHTS DR
Second Line	:	SUITE 300
City	:	ALLEN
State	:	TX
Zip	:	75002-1875
Country	:	US
Telephone Number	:	214-383-7600
Fax Number	:	214-383-7652

Authorized Official
Title or Position	:	SOLE MANAGING MEMBER
Name	:	DR. MANILOM JULIE DOUANGPHILA
Credential	:	OD
Telephone Number	:	214-383-7600

Provider Enumeration Date	:	03/23/2011
Last Update Date	:	04/05/2011

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