=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437378650
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ESLITE EYECARE ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1310 W CAMPBELL RD STE 130
-----------------------------------------------------
City | RICHARDSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75080-2837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-669-1760
-----------------------------------------------------
Fax | 972-669-3362
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1310 W CAMPBELL RD STE 130
-----------------------------------------------------
City | RICHARDSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75080-2837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-669-1760
-----------------------------------------------------
Fax | 972-669-3362
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | DR. JEOU-DER SUNG
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 972-669-1760
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152WC0802X
-----------------------------------------------------
Taxonomy Name | Corneal and Contact Management Optometrist
-----------------------------------------------------
License Number | 4719TG
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------