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General NPI Number Information
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NPI Number | 1619100906
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Entity Type | Organization
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Legal Business Name | PRESTIGE EYECARE LLC
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Dates
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Enumeration Date | 09/02/2009
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Last Update Date | 11/26/2013
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Provider Practice Location Address
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Address Line | 10325 LAKE JUNE RD 110
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City | DALLAS
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State | TX
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Zip | 75217-5312
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Country | US
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Telephone | 972-285-0660
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Fax |
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Provider Business Mailing Address
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Address Line | 10325 LAKE JUNE RD STE 110
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City | DALLAS
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State | TX
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Zip | 75217-5318
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Country | US
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Telephone | 972-285-0660
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. MINA PAKZAD
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Credential | O.D.
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Telephone | 405-922-7291
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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 | 9007315
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License Number State | TX
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