=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831707603
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEWISVILLE EYE CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2020
-----------------------------------------------------
Last Update Date | 07/28/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 190 E ROUND GROVE RD
-----------------------------------------------------
City | LEWISVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75067-8301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-529-6437
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2816 N UMBERLAND DR
-----------------------------------------------------
City | LEWISVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75056-5969
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-529-6437
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BINDI ASHOK DESAI
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 214-529-6437
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------