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General NPI Number Information
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NPI Number | 1710116330
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Entity Type | Organization
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Legal Business Name | IVAN B BANK OD PA INSIGHT COMPLETE EYECARE
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Dates
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Enumeration Date | 07/02/2009
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Last Update Date | 02/10/2010
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Provider Practice Location Address
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Address Line | 8611 HILLCREST AVE SUITE 140
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City | DALLAS
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State | TX
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Zip | 75225-4207
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Country | US
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Telephone | 214-739-8611
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Fax |
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Provider Business Mailing Address
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Address Line | 8611 HILLCREST AVE SUITE 140
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City | DALLAS
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State | TX
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Zip | 75225-4207
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Country | US
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Telephone | 214-739-8611
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Fax |
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. IVAN B BANK
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Credential | O.D.
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Telephone | 504-583-5992
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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 | 03313TG
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License Number State | TX
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