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General NPI Number Information
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NPI Number | 1952515785
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Entity Type | Organization
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Legal Business Name | CORRIDOR EYE, LLC
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3855 LAMAR AVE SUITE A
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City | PARIS
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State | TX
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Zip | 75462-5210
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Country | US
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Telephone | 903-785-1500
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Fax | 903-737-8912
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Provider Business Mailing Address
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Address Line | 1600 HERITAGE DR #1524
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City | MCKINNEY
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State | TX
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Zip | 75069-3481
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Country | US
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Telephone | 903-785-1500
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Fax | 903-737-8912
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL L DEGENAER
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Credential | OD
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Telephone | 903-785-1500
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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 | 4630T
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License Number State | TX
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