=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649543810
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRECISION EYE ASSOCIATES PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2012
-----------------------------------------------------
Last Update Date | 09/20/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2930 PRESTON RD SUITE 905
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75034-9053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-334-9095
-----------------------------------------------------
Fax | 214-705-6322
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2930 PRESTON RD SUITE 905
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75034-9053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-334-9095
-----------------------------------------------------
Fax | 214-705-6322
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OD
-----------------------------------------------------
Name | DIANA S. LEE
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 972-334-9095
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 6597TG
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------