MEDICARE: EYE RISE CLINIC

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	7498	TX

General Provider Information

NPI Number	:	1750627188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE RISE CLINIC

Provider Business Mailing Address
First Line	:	2928 BRITTLEBUSH DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76108-2388
Country	:	US
Telephone Number	:	682-430-1487
Fax Number	:

Provider Business Practice Location Address
First Line	:	6760 WESTWORTH BLVD
Second Line	:
City	:	WESTWORTH VILLAGE
State	:	TX
Zip	:	76114-4002
Country	:	US
Telephone Number	:	682-430-1487
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JACQUELINE HENRIQUEZ
Credential	:	OD
Telephone Number	:	787-549-8025

Provider Enumeration Date	:	12/12/2012
Last Update Date	:	10/07/2024

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Directions to “EYE RISE CLINIC ” Practice Location

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