MEDICARE: EYE EXPRESSIONS

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	6233TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	80907Q	OTHER	TX	BCBS INDIVIDUAL PIN NUMBE
2	005FE	OTHER	TX	BCBS GROUP ID

General Provider Information

NPI Number	:	1851449607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE EXPRESSIONS

Provider Business Mailing Address
First Line	:	5858 MAIN ST
Second Line	:	110
City	:	FRISCO
State	:	TX
Zip	:	75033-4193
Country	:	US
Telephone Number	:	469-633-9339
Fax Number	:	469-633-1880

Provider Business Practice Location Address
First Line	:	5858 MAIN ST
Second Line	:	110
City	:	FRISCO
State	:	TX
Zip	:	75033-4193
Country	:	US
Telephone Number	:	469-633-9339
Fax Number	:	469-633-1880

Authorized Official
Title or Position	:	OWNER
Name	:	STEPHEN TROY MCDANIEL
Credential	:	O.D.
Telephone Number	:	469-633-9339

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	09/15/2014

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Directions to “EYE EXPRESSIONS ” Practice Location

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