Healthcare Provider Details

I. General information

NPI: 1720786775
Provider Name (Legal Business Name): LOW VISION INSTITUTE OF TEXAS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 W PLANO PKWY
PLANO TX
75093-5613
US

IV. Provider business mailing address

4020 W PLANO PKWY
PLANO TX
75093-5613
US

V. Phone/Fax

Practice location:
  • Phone: 469-999-2747
  • Fax: 469-606-0925
Mailing address:
  • Phone: 469-999-2747
  • Fax: 469-606-0925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State

VIII. Authorized Official

Name: LAUREN JOE BAILEY
Title or Position: OWNER
Credential: OD
Phone: 469-999-2747