Healthcare Provider Details

I. General information

NPI: 1346740917
Provider Name (Legal Business Name): CROSS ROADS EYECARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 02/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 US HIGHWAY 380 STE 500
CROSSROADS TX
76227-2516
US

IV. Provider business mailing address

8800 US HIGHWAY 380 STE 500
CROSSROADS TX
76227-2516
US

V. Phone/Fax

Practice location:
  • Phone: 940-488-4228
  • Fax: 940-591-8368
Mailing address:
  • Phone: 940-488-4228
  • Fax: 940-591-8368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HEATH A COLEMAN
Title or Position: OWNER/PROVIDER
Credential: OD
Phone: 940-488-4228