MEDICARE: BLINK EYECARE LLC

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	:	1588006027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLINK EYECARE LLC

Provider Business Mailing Address
First Line	:	6851 VIRGINIA PKWY
Second Line	:	SUITE 101
City	:	MCKINNEY
State	:	TX
Zip	:	75071-5621
Country	:	US
Telephone Number	:	214-865-6266
Fax Number	:	214-865-6305

Provider Business Practice Location Address
First Line	:	6851 VIRGINIA PKWY
Second Line	:	SUITE 101
City	:	MCKINNEY
State	:	TX
Zip	:	75071-5621
Country	:	US
Telephone Number	:	214-865-6266
Fax Number	:	214-865-6305

Authorized Official
Title or Position	:	OWNER
Name	:	KAYLA GADDIS
Credential	:
Telephone Number	:	214-865-6266

Provider Enumeration Date	:	07/25/2013
Last Update Date	:	07/25/2013

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