MEDICARE: CENTRAL VISION 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

General Provider Information

NPI Number	:	1780291773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL VISION CLINIC

Provider Business Mailing Address
First Line	:	2400 K AVE STE 2400E
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75074-5942
Country	:	US
Telephone Number	:	972-424-7236
Fax Number	:	972-423-0614

Provider Business Practice Location Address
First Line	:	2400 K AVE STE 2400E
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75074-5942
Country	:	US
Telephone Number	:	972-424-7236
Fax Number	:	972-423-0614

Authorized Official
Title or Position	:	MANAGER
Name	:	ROSIE SALAS
Credential	:
Telephone Number	:	972-424-7236

Provider Enumeration Date	:	09/24/2020
Last Update Date	:	09/24/2020

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Directions to “CENTRAL VISION CLINIC ” Practice Location

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