Healthcare Provider Details

I. General information

NPI: 1780165084
Provider Name (Legal Business Name): B AND B OPTICAL MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 03/08/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16100 SAM RAYBURN TOLLWAY BUILDING A #130
FRISCO TX
75035
US

IV. Provider business mailing address

7579 OLIVIA CT
WAYNESVILLE OH
45068-7205
US

V. Phone/Fax

Practice location:
  • Phone: 469-217-7300
  • Fax: 561-828-8367
Mailing address:
  • Phone: 561-275-2020
  • 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: JACKIE BENNETT
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 561-433-6009