=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093157844
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARMEL MARY CLEETUS O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2013
-----------------------------------------------------
Last Update Date | 08/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6464 E NORTHWEST HWY STE 212
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75214-7802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-579-9929
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2648 EL CAMINO LN
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75212-2922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-588-1537
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 8247T
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------