MEDICARE: IVAN B BANK OD PA INSIGHT COMPLETE EYECARE

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	03313TG	TX

General Provider Information

NPI Number	:	1710116330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IVAN B BANK OD PA INSIGHT COMPLETE EYECARE

Provider Business Mailing Address
First Line	:	8611 HILLCREST AVE
Second Line	:	SUITE 140
City	:	DALLAS
State	:	TX
Zip	:	75225-4207
Country	:	US
Telephone Number	:	214-739-8611
Fax Number	:

Provider Business Practice Location Address
First Line	:	8611 HILLCREST AVE
Second Line	:	SUITE 140
City	:	DALLAS
State	:	TX
Zip	:	75225-4207
Country	:	US
Telephone Number	:	214-739-8611
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DOCTOR
Name	:	DR. IVAN B BANK
Credential	:	O.D.
Telephone Number	:	504-583-5992

Provider Enumeration Date	:	07/02/2009
Last Update Date	:	02/10/2010

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