Healthcare Provider Details

I. General information

NPI: 1780864066
Provider Name (Legal Business Name): MIDWAY EYE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 MIDWAY RD SUITE 421
PLANO TX
75093-8138
US

IV. Provider business mailing address

3405 MIDWAY RD SUITE 421
PLANO TX
75093-8138
US

V. Phone/Fax

Practice location:
  • Phone: 972-801-2727
  • Fax: 972-943-3485
Mailing address:
  • Phone: 972-801-2727
  • Fax: 972-943-3485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number6060TG
License Number StateTX

VIII. Authorized Official

Name: DR. DEBORAH ANN BROUSSARD
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 972-801-2727