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General NPI Number Information
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NPI Number | 1831083658
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Entity Type | Organization
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Legal Business Name | EYES ON SOUTHLAKE PLLC
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Dates
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Enumeration Date | 06/05/2025
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 2813 W SOUTHLAKE BLVD STE 120
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6832
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Country | US
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Telephone | 817-305-7171
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Fax | 817-305-7172
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Provider Business Mailing Address
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Address Line | 2813 W SOUTHLAKE BLVD STE 120
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6832
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Country | US
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Telephone | 817-305-7171
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Fax | 817-305-7172
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Authorized Official
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Title or Position | OD/OWNER
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Name | JOHN L BASS
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Credential | OD
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Telephone | 817-305-7171
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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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