Basic Information
| Provider Information | |||||||||
| NPI: | 1225153869 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RICHARDSON VISION & CONTACT LENS CLINIC, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1120 W CAMPBELL RD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | RICHARDSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750802977 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722313439 | ||||||||
| FaxNumber: | 9722310260 | ||||||||
| Practice Location | |||||||||
| Address1: | 1120 W CAMPBELL RD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | RICHARDSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750802977 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722313439 | ||||||||
| FaxNumber: | 9722310260 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 05/19/2010 | ||||||||
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| AuthorizedOfficialLastName: | SPARKS | ||||||||
| AuthorizedOfficialFirstName: | JERYL | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9722313439 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X | 2134TG | TX | Y | Suppliers | Eyewear Supplier (Equipment, not the service) |
No ID Information.