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General NPI Number Information
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NPI Number | 1467251272
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Entity Type | Organization
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Legal Business Name | ENVISION RETINA PLLC
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Dates
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Enumeration Date | 03/12/2025
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Last Update Date | 04/15/2026
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Provider Practice Location Address
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Address Line | 5576 N SHILOH RD
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City | GARLAND
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State | TX
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Zip | 75044-6614
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Country | US
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Telephone | 469-248-7365
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Fax | 469-242-9745
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Provider Business Mailing Address
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Address Line | 5576 N SHILOH RD
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City | GARLAND
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State | TX
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Zip | 75044-6614
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Country | US
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Telephone | 469-248-7365
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Fax | 469-242-9745
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Authorized Official
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Title or Position | OWNER AND MANAGER
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Name | WASIM SAMARA
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Credential | MD
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Telephone | 469-248-7365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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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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