Healthcare Provider Details

I. General information

NPI: 1851687644
Provider Name (Legal Business Name): ECSC II, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 S HULEN ST SUITE 100
FORT WORTH TX
76109-1504
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: 214-361-1433
  • Fax: 214-368-8365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number
License Number State

VIII. Authorized Official

Name: WESLEY K HERMAN
Title or Position: PRESIDENT, OWNER
Credential: M.D.
Phone: 214-361-1443