Healthcare Provider Details

I. General information

NPI: 1235602525
Provider Name (Legal Business Name): MIDLOTHIAN VISION ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2019
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 FM 663 STE 320
MIDLOTHIAN TX
76065-6566
US

IV. Provider business mailing address

2020 FM 663 STE 320
MIDLOTHIAN TX
76065-6566
US

V. Phone/Fax

Practice location:
  • Phone: 469-672-6060
  • Fax:
Mailing address:
  • Phone: 469-672-6060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SHAWN M PRAPTA
Title or Position: OWNER/OPTOMETRIST
Credential: OD
Phone: 682-518-1177