Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8611 HILLCREST AVE SUITE 140
DALLAS TX
75225-4207
US

IV. Provider business mailing address

8611 HILLCREST AVE SUITE 140
DALLAS TX
75225-4207
US

V. Phone/Fax

Practice location:
  • Phone: 214-739-8611
  • Fax:
Mailing address:
  • Phone: 214-739-8611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number03313TG
License Number StateTX

VIII. Authorized Official

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