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General NPI Number Information
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NPI Number | 1770392342
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Entity Type | Organization
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Legal Business Name | PROVECTUS FAMILY EYECARE PLLC
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Dates
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Enumeration Date | 01/07/2025
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 4101 HIGHWAY 121 STE 100
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City | BEDFORD
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State | TX
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Zip | 76021-3053
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Country | US
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Telephone | 817-494-3049
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Fax |
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Provider Business Mailing Address
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Address Line | 3414 BEVANN DR
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City | FARMERS BRANCH
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State | TX
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Zip | 75234-6548
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Country | US
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Telephone | 469-237-0805
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Fax |
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | JOSEPH VU
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Credential | OD
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Telephone | 469-237-0805
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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 |
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License Number State |
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