MEDICARE: OPTICAL CONCEPTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302R00000X	Health Maintenance Organization	06631TG	TX

General Provider Information

NPI Number	:	1073775383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTICAL CONCEPTS

Provider Business Mailing Address
First Line	:	5975 S COOPER ST STE 121
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-4400
Country	:	US
Telephone Number	:	817-557-5101
Fax Number	:	817-557-0230

Provider Business Practice Location Address
First Line	:	5975 S COOPER ST STE 121
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-4400
Country	:	US
Telephone Number	:	817-557-5101
Fax Number	:	817-557-0230

Authorized Official
Title or Position	:	DOCTOR/PRESIDENT
Name	:	DR. HOANG-QUAN D PHAM
Credential	:	O.D.
Telephone Number	:	817-557-5101

Provider Enumeration Date	:	06/27/2008
Last Update Date	:	02/22/2011

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Directions to “OPTICAL CONCEPTS ” Practice Location

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