Healthcare Provider Details

I. General information

NPI: 1407385388
Provider Name (Legal Business Name): KUDO CARE OPTOMETRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 06/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 GRANDE BULEVAR
IRVING TX
75062-5108
US

IV. Provider business mailing address

2201 LONG PRAIRIE RD STE 107-315
FLOWER MOUND TX
75022-4832
US

V. Phone/Fax

Practice location:
  • Phone: 972-258-8354
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ALEXANDRA LY
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 832-398-5626