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General NPI Number Information
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NPI Number | 1992277123
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Entity Type | Organization
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Legal Business Name | SUPERIOR EYE CARE PC
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Dates
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Enumeration Date | 12/28/2018
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Last Update Date | 12/28/2018
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Provider Practice Location Address
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Address Line | 5912 CONVAIR DR STE 208
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City | FORT WORTH
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State | TX
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Zip | 76109-1269
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Country | US
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Telephone | 817-880-7917
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Fax | 817-378-4707
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Provider Business Mailing Address
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Address Line | 5912 CONVAIR DR STE 208
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City | FORT WORTH
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State | TX
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Zip | 76109-1269
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Country | US
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Telephone | 817-880-7917
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Fax | 817-378-4707
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID MOORE
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Credential | OD
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Telephone | 713-591-7918
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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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