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General NPI Number Information
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NPI Number | 1225319247
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Entity Type | Organization
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Legal Business Name | PRESTIGE VISION
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Dates
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Enumeration Date | 09/03/2011
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Last Update Date | 09/03/2011
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Provider Practice Location Address
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Address Line | 2317 SOUTHBAY CIR
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City | ROWLETT
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State | TX
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Zip | 75088-5531
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Country | US
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Telephone | 214-728-6716
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Fax |
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Provider Business Mailing Address
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Address Line | 601 S PLANO RD
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City | RICHARDSON
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State | TX
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Zip | 75081-4512
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Country | US
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Telephone | 214-613-5204
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. ROXY MARKOSE
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Credential | O.D.
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Telephone | 214-728-6716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 7707T
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License Number State | TX
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