MEDICARE: DR ALLEN'S 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	05370TG	TX

General Provider Information

NPI Number	:	1386188563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR ALLEN'S EYE CARE PLLC

Provider Business Mailing Address
First Line	:	4401 GALLERIA OAKS DR, STE B
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503
Country	:	US
Telephone Number	:	903-838-9063
Fax Number	:	833-811-8332

Provider Business Practice Location Address
First Line	:	3304 RICHMOND RD
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-0703
Country	:	US
Telephone Number	:	430-200-0036
Fax Number	:

Authorized Official
Title or Position	:	BILLING COORDINATOR
Name	:	MRS. NICOLE CRIBBS
Credential	:
Telephone Number	:	903-838-9063

Provider Enumeration Date	:	12/07/2016
Last Update Date	:	05/29/2019

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