Healthcare Provider Details

I. General information

NPI: 1881940450
Provider Name (Legal Business Name): CRYSTAL EYLAR O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 HAWKINS RUN RD STE 300-400
MIDLOTHIAN TX
76065-6664
US

IV. Provider business mailing address

6461 STILL WATERS CT
MIDLOTHIAN TX
76065-1785
US

V. Phone/Fax

Practice location:
  • Phone: 832-477-3008
  • Fax:
Mailing address:
  • Phone: 832-477-3008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number8074T
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: