Healthcare Provider Details

I. General information

NPI: 1528290954
Provider Name (Legal Business Name): JP AL EYE ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 01/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PRECINCT LINE RD
HURST TX
76053-3828
US

IV. Provider business mailing address

1400 PRECINCT LINE RD
HURST TX
76053-3828
US

V. Phone/Fax

Practice location:
  • Phone: 817-282-1975
  • Fax:
Mailing address:
  • Phone: 214-490-8784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7408TG
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number7408TG
License Number StateTX

VIII. Authorized Official

Name: AARON LEE
Title or Position: MANAGING MEMBER
Credential: OD
Phone: 214-490-8784