MEDICARE: SAGINAW FAMILY EYECARE, 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	:	1265106280
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAGINAW FAMILY EYECARE, PLLC

Provider Business Mailing Address
First Line	:	9816 N BEACH ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-6184
Country	:	US
Telephone Number	:	817-741-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	616 E BAILEY BOSWELL RD STE 200
Second Line	:
City	:	SAGINAW
State	:	TX
Zip	:	76131-3575
Country	:	US
Telephone Number	:	817-741-2020
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANJONETTE COLVIN
Credential	:	OD
Telephone Number	:	817-701-8775

Provider Enumeration Date	:	08/03/2021
Last Update Date	:	08/03/2021

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