MEDICARE: NEURO EYE TEAM 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	152WV0400X	Vision Therapy Optometrist

General Provider Information

NPI Number	:	1740813005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEURO EYE TEAM PLLC

Provider Business Mailing Address
First Line	:	6612 N RIVERSIDE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-6663
Country	:	US
Telephone Number	:	817-918-3337
Fax Number	:	817-918-3337

Provider Business Practice Location Address
First Line	:	6612 N RIVERSIDE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-6663
Country	:	US
Telephone Number	:	817-918-3337
Fax Number	:	817-918-3337

Authorized Official
Title or Position	:	OWNER
Name	:	ALEX CONLEY
Credential	:	OD
Telephone Number	:	817-918-3337

Provider Enumeration Date	:	02/14/2020
Last Update Date	:	02/14/2020

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