Healthcare Provider Details

I. General information

NPI: 1508660580
Provider Name (Legal Business Name): FREEDOM VISION CONSULTANTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 E SOUTHLAKE BLVD STE 200
SOUTHLAKE TX
76092-1588
US

IV. Provider business mailing address

925 E SOUTHLAKE BLVD STE 200
SOUTHLAKE TX
76092-1588
US

V. Phone/Fax

Practice location:
  • Phone: 817-416-8561
  • Fax: 817-416-3661
Mailing address:
  • Phone: 817-360-5418
  • Fax: 817-416-3661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT LYONS
Title or Position: OWNER
Credential: MD
Phone: 817-416-8561