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General NPI Number Information
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NPI Number | 1447780200
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Entity Type | Organization
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Legal Business Name | EYECONIC VISION, PLLC
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Dates
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Enumeration Date | 06/14/2017
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Last Update Date | 06/14/2017
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Provider Practice Location Address
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Address Line | 10720 PRESTON RD STE 1003
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City | DALLAS
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State | TX
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Zip | 75230-8808
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Country | US
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Telephone | 214-696-4132
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Fax |
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Provider Business Mailing Address
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Address Line | 4210 FAIRMOUNT ST APT 3079
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City | DALLAS
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State | TX
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Zip | 75219-3579
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Country | US
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Telephone | 817-907-0243
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | HANH NGUYEN
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Credential | OD
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Telephone | 817-907-0243
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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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