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General NPI Number Information
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NPI Number | 1699905695
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Entity Type | Organization
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Legal Business Name | HP PURE VISION EYE CARE PLLC
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Dates
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Enumeration Date | 07/24/2009
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Last Update Date | 07/23/2012
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Provider Practice Location Address
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Address Line | 2615 W PIONEER PKWY STE 105
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City | GRAND PRAIRIE
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State | TX
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Zip | 75051-3602
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Country | US
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Telephone | 972-636-8070
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Fax |
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Provider Business Mailing Address
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Address Line | 2615 W PIONEER PKWY STE 105
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City | GRAND PRAIRIE
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State | TX
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Zip | 75051-3602
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Country | US
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Telephone | 972-636-8070
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Fax |
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Authorized Official
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Title or Position | THERAPEUTIC OPTOMETRIST
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Name | MYCHELE TRAN
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Credential | O.D.
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Telephone | 972-636-8070
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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 | 7142T
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License Number State | TX
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