MEDICARE: COLONY VISION CENTER PC

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	:	1538582127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLONY VISION CENTER PC

Provider Business Mailing Address
First Line	:	4709 HIGHWAY 121
Second Line	:	SUITE 122
City	:	THE COLONY
State	:	TX
Zip	:	75056-2914
Country	:	US
Telephone Number	:	972-625-2020
Fax Number	:	972-624-5357

Provider Business Practice Location Address
First Line	:	4709 HIGHWAY 121
Second Line	:	SUITE 122
City	:	THE COLONY
State	:	TX
Zip	:	75056-2914
Country	:	US
Telephone Number	:	972-625-2020
Fax Number	:	972-624-5357

Authorized Official
Title or Position	:	OD/OWNER
Name	:	JASON PRESCOTT
Credential	:	OD/OWNER
Telephone Number	:	972-624-5967

Provider Enumeration Date	:	02/03/2014
Last Update Date	:	02/03/2014

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Directions to “COLONY VISION CENTER PC ” Practice Location

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