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General NPI Number Information
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NPI Number | 1780864066
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Entity Type | Organization
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Legal Business Name | MIDWAY EYE ASSOCIATES
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Dates
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Enumeration Date | 11/05/2007
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Last Update Date | 11/07/2007
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Provider Practice Location Address
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Address Line | 3405 MIDWAY RD SUITE 421
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City | PLANO
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State | TX
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Zip | 75093-8138
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Country | US
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Telephone | 972-801-2727
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Fax | 972-943-3485
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Provider Business Mailing Address
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Address Line | 3405 MIDWAY RD SUITE 421
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City | PLANO
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State | TX
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Zip | 75093-8138
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Country | US
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Telephone | 972-801-2727
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Fax | 972-943-3485
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. DEBORAH ANN BROUSSARD
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Credential | O.D.
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Telephone | 972-801-2727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 6060TG
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License Number State | TX
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