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General NPI Number Information
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NPI Number | 1841798493
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Entity Type | Organization
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Legal Business Name | EYE SOURCE PLLC
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Dates
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Enumeration Date | 01/30/2018
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Last Update Date | 04/06/2018
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Provider Practice Location Address
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Address Line | 8049 PRESTON RD STE 200
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City | FRISCO
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State | TX
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Zip | 75034-8260
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Country | US
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Telephone | 254-718-1275
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Fax |
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Provider Business Mailing Address
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Address Line | 316 CRIPPLE CREEK DR
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City | CELINA
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State | TX
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Zip | 75009-4670
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Country | US
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Telephone |
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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 | DR. CAREY BROOKS
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Credential | OD
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Telephone | 254-718-1275
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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 | 7327
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License Number State | TX
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