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General NPI Number Information
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NPI Number | 1952724924
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Entity Type | Organization
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Legal Business Name | ROANOKE FAMILY EYECARE
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Dates
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Enumeration Date | 01/28/2014
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Last Update Date | 12/02/2023
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Provider Practice Location Address
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Address Line | 361 W SOUTHLAKE BLVD STE 100
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City | SOUTHLAKE
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State | TX
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Zip | 76092-1481
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Country | US
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Telephone | 817-491-4994
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 630917
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City | IRVING
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State | TX
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Zip | 75063-0137
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Country | US
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Telephone | 972-693-0677
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. NANCY DAVIS
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Credential | O.D.
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Telephone | 817-491-4994
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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 | 5822-T
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License Number State | TX
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