=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053550202
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMERICAN EYECARE CENTERS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2009
-----------------------------------------------------
Last Update Date | 07/17/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6036 SHERRY LN
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75225-6401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-361-1300
-----------------------------------------------------
Fax | 214-361-7310
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6036 SHERRY LN
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75225-6401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-361-1300
-----------------------------------------------------
Fax | 214-361-7310
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | INSURANCE COORDINATOR
-----------------------------------------------------
Name | MS. SHELLEY G MINER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-361-1300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 02227TG
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------