MEDICARE: HERITAGE EYE CENTER LC

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	261QA1903X	Ambulatory Surgical Clinic/Center	000253	TX

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	:	1205881935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERITAGE EYE CENTER LC

Provider Business Mailing Address
First Line	:	1501-B REDBUD BLVD
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75069
Country	:	US
Telephone Number	:	972-548-0771
Fax Number	:	972-562-2300

Provider Business Practice Location Address
First Line	:	1501-B REDBUD BLVD
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75069
Country	:	US
Telephone Number	:	972-548-0771
Fax Number	:	972-562-2300

Authorized Official
Title or Position	:	OFFICER AND AUTHORIZED OFFICIAL
Name	:	JENNIFER BOYD BALDOCK
Credential	:
Telephone Number	:	615-234-5954

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	02/13/2024

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Directions to “HERITAGE EYE CENTER LC ” Practice Location

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