Healthcare Provider Details

I. General information

NPI: 1437378650
Provider Name (Legal Business Name): ESLITE EYECARE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W CAMPBELL RD STE 130
RICHARDSON TX
75080-2837
US

IV. Provider business mailing address

1310 W CAMPBELL RD STE 130
RICHARDSON TX
75080-2837
US

V. Phone/Fax

Practice location:
  • Phone: 972-669-1760
  • Fax: 972-669-3362
Mailing address:
  • Phone: 972-669-1760
  • Fax: 972-669-3362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number4719TG
License Number StateTX

VIII. Authorized Official

Name: DR. JEOU-DER SUNG
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 972-669-1760