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General NPI Number Information
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NPI Number | 1407044274
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Entity Type | Organization
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Legal Business Name | IMAGE VISION & LASER CENTER PLLC
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Dates
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Enumeration Date | 10/05/2007
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Last Update Date | 10/05/2007
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Provider Practice Location Address
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Address Line | 13601 PRESTON RD SUITE 600 WEST TOWER
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City | DALLAS
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State | TX
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Zip | 75240-4911
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Country | US
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Telephone | 972-701-0600
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Fax | 972-701-0605
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Provider Business Mailing Address
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Address Line | 13601 PRESTON RD SUITE 600 WEST TOWER
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City | DALLAS
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State | TX
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Zip | 75240-4911
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Country | US
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Telephone | 972-701-0600
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Fax | 972-701-0605
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Authorized Official
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Title or Position | OWNER
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Name | CATHEY FARMER
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Credential |
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Telephone | 972-701-0600
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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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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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