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General NPI Number Information
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NPI Number | 1952847436
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Entity Type | Organization
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Legal Business Name | CARLENS LUXURY OPTICAL LLC
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Dates
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Enumeration Date | 01/09/2017
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Last Update Date | 01/09/2017
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Provider Practice Location Address
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Address Line | 8020 PARK LN SUITE 110
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City | DALLAS
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State | TX
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Zip | 75231-6055
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Country | US
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Telephone | 972-824-4204
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Fax |
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Provider Business Mailing Address
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Address Line | 8020 PARK LN SUITE 110
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City | DALLAS
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State | TX
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Zip | 75231-6055
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Country | US
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Telephone | 972-824-4204
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. EDWARD CARMONA
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Credential | D.O
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Telephone | 972-824-0325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FC0801X
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Taxonomy Name | Contact Lens Fitter
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License Number | 223731
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License Number State | TX
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