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General NPI Number Information
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NPI Number | 1851708705
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE EYE CARE, P.A.
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Dates
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Enumeration Date | 07/11/2014
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Last Update Date | 07/11/2014
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Provider Practice Location Address
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Address Line | 8080 INDEPENDENCE PARKWAY SUITE 100
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City | PLANO
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State | TX
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Zip | 75025
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Country | US
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Telephone | 972-334-9095
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Fax |
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Provider Business Mailing Address
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Address Line | 2930 PRESTON RD STE 905
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City | FRISCO
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State | TX
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Zip | 75034-9056
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Country | US
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Telephone | 972-334-9095
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | DIANA PARK
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Credential |
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Telephone | 972-334-9095
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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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