Healthcare Provider Details

I. General information

NPI: 1598762197
Provider Name (Legal Business Name): JOSEPH M CONSTABLE OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5421 LA SIERRA DR
DALLAS TX
75231-4107
US

IV. Provider business mailing address

5421 LA SIERRA DR
DALLAS TX
75231-4107
US

V. Phone/Fax

Practice location:
  • Phone: 214-361-1443
  • Fax: 214-368-8365
Mailing address:
  • Phone: 214-361-1443
  • Fax: 214-368-8365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number05673TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: