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General NPI Number Information
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NPI Number | 1073775383
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Entity Type | Organization
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Legal Business Name | OPTICAL CONCEPTS
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Dates
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Enumeration Date | 06/27/2008
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Last Update Date | 02/22/2011
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Provider Practice Location Address
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Address Line | 5975 S COOPER ST STE 121
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City | ARLINGTON
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State | TX
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Zip | 76017-4400
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Country | US
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Telephone | 817-557-5101
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Fax | 817-557-0230
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Provider Business Mailing Address
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Address Line | 5975 S COOPER ST STE 121
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City | ARLINGTON
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State | TX
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Zip | 76017-4400
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Country | US
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Telephone | 817-557-5101
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Fax | 817-557-0230
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Authorized Official
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Title or Position | DOCTOR/PRESIDENT
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Name | DR. HOANG-QUAN D PHAM
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Credential | O.D.
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Telephone | 817-557-5101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 06631TG
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License Number State | TX
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