Healthcare Provider Details

I. General information

NPI: 1881842367
Provider Name (Legal Business Name): MT PLEASANT EYE CARE CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 06/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W FERGUSON RD SUITE 2020
MT PLEASANT TX
75455-2925
US

IV. Provider business mailing address

2001 W FERGUSON RD SUITE 2020
MT PLEASANT TX
75455-2925
US

V. Phone/Fax

Practice location:
  • Phone: 903-572-1991
  • Fax: 903-572-4718
Mailing address:
  • Phone: 903-572-1991
  • Fax: 903-572-4718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. BRIAN K NICHOLS
Title or Position: OWNER
Credential: OD
Phone: 903-572-4718