Basic Information
| Provider Information | |||||||||
| NPI: | 1083144661 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CORSICANA FIRST EYECARE PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6446 LBJ FWY | ||||||||
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| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752406407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729602020 | ||||||||
| FaxNumber: | 9729602063 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 N 15TH ST | ||||||||
| Address2: | |||||||||
| City: | CORSICANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751104514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9038722561 | ||||||||
| FaxNumber: | 9038725273 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2017 | ||||||||
| LastUpdateDate: | 06/15/2017 | ||||||||
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| AuthorizedOfficialLastName: | FARRELL | ||||||||
| AuthorizedOfficialFirstName: | MONA | ||||||||
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| AuthorizedOfficialTitleorPosition: | INSURANCE SPECIALISTS | ||||||||
| AuthorizedOfficialTelephone: | 9729602020 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.