MEDICARE: TEXOMA FAMILY EYE CARE CLINIC 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	152W00000X	Optometrist	3892T	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8F0247	OTHER	TX	REFERRING PROVIDER ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MO001348245	OTHER	TX	HIGHMARK BCBS/ALCOA
4	0022FC	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1982780615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXOMA FAMILY EYE CARE CLINIC PA

Provider Business Mailing Address
First Line	:	4102 JACKSBORO HWY
Second Line	:	SUITE 100
City	:	WICHITA FALLS
State	:	TX
Zip	:	76302-2747
Country	:	US
Telephone Number	:	940-696-9072
Fax Number	:	940-761-1115

Provider Business Practice Location Address
First Line	:	4102 JACKSBORO HWY
Second Line	:	SUITE 100
City	:	WICHITA FALLS
State	:	TX
Zip	:	76302-2747
Country	:	US
Telephone Number	:	940-696-9072
Fax Number	:	940-761-1115

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LEEANN MOLL-LEAR
Credential	:	O.D.
Telephone Number	:	940-696-9072

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	05/09/2008

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Directions to “TEXOMA FAMILY EYE CARE CLINIC PA ” Practice Location

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