Healthcare Provider Details

I. General information

NPI: 1538350608
Provider Name (Legal Business Name): STONEBRIDGE EYE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 08/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3109 S CUSTER RD SUITE 200
MCKINNEY TX
75070-7170
US

IV. Provider business mailing address

3109 S CUSTER RD SUITE 200
MCKINNEY TX
75070-7170
US

V. Phone/Fax

Practice location:
  • Phone: 469-569-2782
  • Fax: 214-705-6002
Mailing address:
  • Phone: 469-569-2782
  • Fax: 214-705-6002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number6248T
License Number StateTX

VIII. Authorized Official

Name: DR. ALLEN QUACH
Title or Position: PRESIDENT
Credential: O.D.
Phone: 469-569-2782