MEDICARE: ALJP VISION, PLLC

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	152WC0802X	Corneal and Contact Management Optometrist	7408TG	TX
2	152W00000X	Optometrist	7417TG	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	TXB102634	OTHER	TX	MEDICARE PART B PROVIDER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073843066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALJP VISION, PLLC

Provider Business Mailing Address
First Line	:	5310 N TARRANT PKWY
Second Line	:	STE 128
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5386
Country	:	US
Telephone Number	:	817-514-2114
Fax Number	:	817-514-2150

Provider Business Practice Location Address
First Line	:	5310 N TARRANT PKWY
Second Line	:	STE 128
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5386
Country	:	US
Telephone Number	:	817-514-2114
Fax Number	:	817-514-2150

Authorized Official
Title or Position	:	OPTOMETRIST/MANAGING MEMBER
Name	:	DR. JORDAN PIERCE
Credential	:	O.D.
Telephone Number	:	817-514-2114

Provider Enumeration Date	:	01/13/2010
Last Update Date	:	01/10/2011

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Directions to “ALJP VISION, PLLC ” Practice Location

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