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General NPI Number Information
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NPI Number | 1912189374
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Entity Type | Organization
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Legal Business Name | CEDAR PARK EYE CARE PA
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 01/08/2019
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Provider Practice Location Address
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Address Line | 210 N LAKELINE BLVD STE 100
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City | CEDAR PARK
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State | TX
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Zip | 78613-2088
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Country | US
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Telephone | 512-249-0808
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Fax | 512-249-0828
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Provider Business Mailing Address
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Address Line | 210 N LAKELINE BLVD STE 100
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City | CEDAR PARK
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State | TX
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Zip | 78613-2088
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Country | US
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Telephone | 512-249-0808
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Fax | 512-249-0828
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Authorized Official
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Title or Position | OWNER
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Name | DENNIS ROLAND MCCARTY
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Credential | OD
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Telephone | 512-249-0808
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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 | 5874TG
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License Number State | TX
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