=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083047856
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRAL EXPRESSWAY OPTICAL INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2013
-----------------------------------------------------
Last Update Date | 01/07/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10910 N CENTRAL EXPY SUITE #700
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75231-2500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-373-8100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10910 N CENTRAL EXPY SUITE #700
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75231-2500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-373-8100
-----------------------------------------------------
Fax | 214-234-0192
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ERIC PAUL KINSELLA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-373-8100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------