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General NPI Number Information
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NPI Number | 1104599430
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Entity Type | Organization
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Legal Business Name | TEXARKANA EYE CARE CENTER LLP
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Dates
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Enumeration Date | 08/02/2021
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Last Update Date | 08/02/2021
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Provider Practice Location Address
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Address Line | 101 TYSON ST
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City | NEW BOSTON
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State | TX
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Zip | 75570-2821
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Country | US
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Telephone | 903-628-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 4401 GALLERIA OAKS DR
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City | TEXARKANA
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State | TX
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Zip | 75503-4675
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Country | US
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Telephone | 903-838-9063
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Fax |
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Authorized Official
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Title or Position | OWNER / OPTOMETRIST
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Name | MARK ALLEN
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Credential | OD
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Telephone | 903-838-9063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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