=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154034775
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TEXAS EYE & AESTHETIC CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2022
-----------------------------------------------------
Last Update Date | 12/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3950 W PLANO PKWY STE A
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75075-7805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-519-9933
-----------------------------------------------------
Fax | 972-468-1434
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3950 W PLANO PKWY STE A
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75075-7805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-519-9933
-----------------------------------------------------
Fax | 972-468-1434
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | MS. SABRINA CISNEROS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 972-519-9933
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------