MEDICARE: ECSC II, PA

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	156FX1100X	Ophthalmic Technician/Technologist

General Provider Information

NPI Number	:	1851687644
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ECSC II, PA

Provider Business Mailing Address
First Line	:	5421 LA SIERRA DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4107
Country	:	US
Telephone Number	:	214-361-1433
Fax Number	:	214-368-8365

Provider Business Practice Location Address
First Line	:	2800 S HULEN ST
Second Line	:	SUITE 100
City	:	FORT WORTH
State	:	TX
Zip	:	76109-1504
Country	:	US
Telephone Number	:	214-361-1443
Fax Number	:	214-368-8365

Authorized Official
Title or Position	:	PRESIDENT, OWNER
Name	:	WESLEY K HERMAN
Credential	:	M.D.
Telephone Number	:	214-361-1443

Provider Enumeration Date	:	06/21/2011
Last Update Date	:	06/21/2011

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