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General NPI Number Information
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NPI Number | 1023511235
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Entity Type | Organization
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Legal Business Name | ARLINGTON VISION CARE PA
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Dates
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Enumeration Date | 03/14/2018
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Last Update Date | 03/14/2018
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Provider Practice Location Address
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Address Line | 5425 MATLOCK RD STE 100
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City | ARLINGTON
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State | TX
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Zip | 76018-1558
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Country | US
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Telephone | 817-557-4100
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Fax | 817-557-4176
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Provider Business Mailing Address
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Address Line | 5425 MATLOCK RD STE 100
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City | ARLINGTON
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State | TX
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Zip | 76018-1558
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Country | US
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Telephone | 817-557-4100
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Fax | 817-557-4176
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RUSSELL KEITH CROSIER
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Credential |
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Telephone | 817-557-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 4961TG
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License Number State | TX
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