MEDICARE: ON-SITE EYE CARE 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	152W00000X	Optometrist

General Provider Information

NPI Number	:	1093466955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ON-SITE EYE CARE PLLC

Provider Business Mailing Address
First Line	:	4949 WESTGROVE DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75248-1923
Country	:	US
Telephone Number	:	972-961-3257
Fax Number	:

Provider Business Practice Location Address
First Line	:	6629 HYACINTH LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75252-5918
Country	:	US
Telephone Number	:	972-961-3257
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	BETH SUMMERS
Credential	:	OD
Telephone Number	:	443-717-0489

Provider Enumeration Date	:	01/12/2022
Last Update Date	:	10/18/2023

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Directions to “ON-SITE EYE CARE PLLC ” Practice Location

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