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General NPI Number Information
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NPI Number | 1770830507
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Entity Type | Organization
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Legal Business Name | VISION PALACE, P.C.
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Dates
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Enumeration Date | 08/10/2012
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Last Update Date | 08/10/2012
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Provider Practice Location Address
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Address Line | 3751 MATLOCK RD STE 115
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City | ARLINGTON
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State | TX
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Zip | 76015-4342
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Country | US
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Telephone | 817-375-9000
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Fax | 817-375-9005
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Provider Business Mailing Address
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Address Line | 3751 MATLOCK RD STE 115
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City | ARLINGTON
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State | TX
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Zip | 76015-4342
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Country | US
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Telephone | 817-375-9000
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Fax | 817-375-9005
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LAQUIESHA DENISE WOODS
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Credential |
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Telephone | 972-274-6600
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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 | 07098TG
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License Number State | TX
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