Healthcare Provider Details

I. General information

NPI: 1427347442
Provider Name (Legal Business Name): EYEQ VISION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 08/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8380 WARREN PKWY SUITE 605
FRISCO TX
75034-4198
US

IV. Provider business mailing address

8380 WARREN PKWY SUITE 605
FRISCO TX
75034-4198
US

V. Phone/Fax

Practice location:
  • Phone: 972-668-3131
  • Fax:
Mailing address:
  • Phone: 972-668-3131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ANISAH SHAHIDZADEH
Title or Position: OPTOMETRIC DIRECTOR
Credential: O.D.
Phone: 972-668-3131