Healthcare Provider Details

I. General information

NPI: 1790284461
Provider Name (Legal Business Name): AMERICAN EYELABS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2018
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 S COOPER ST STE 100
ARLINGTON TX
76015-3467
US

IV. Provider business mailing address

9708 CAPILANO DR
PLANO TX
75025-6496
US

V. Phone/Fax

Practice location:
  • Phone: 682-219-1301
  • Fax: 561-828-8367
Mailing address:
  • Phone: 561-275-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: JACKIE BENNETT
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 561-433-6009