Healthcare Provider Details

I. General information

NPI: 1134691454
Provider Name (Legal Business Name): DUA VISION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2018
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 N JOSEY LN STE 100
CARROLLTON TX
75006-1661
US

IV. Provider business mailing address

2510 N JOSEY LN STE 100
CARROLLTON TX
75006-1661
US

V. Phone/Fax

Practice location:
  • Phone: 469-491-1414
  • Fax: 561-828-8367
Mailing address:
  • Phone: 469-491-1414
  • Fax: 561-828-8367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

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