Healthcare Provider Details

I. General information

NPI: 1588323976
Provider Name (Legal Business Name): MEL DALLAS LOVE FIELD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 12/13/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 W NORTHWEST HWY STE 430
DALLAS TX
75220-4955
US

IV. Provider business mailing address

1784 W MCDERMOTT DR STE 110
ALLEN TX
75013-3396
US

V. Phone/Fax

Practice location:
  • Phone: 956-335-6476
  • Fax:
Mailing address:
  • Phone:
  • 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: DANIEL GARZA
Title or Position: MANAGED CARE DIRECTOR
Credential:
Phone: 561-720-6423