Basic Information
| Provider Information | |||||||||
| NPI: | 1265106280 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAGINAW FAMILY EYECARE, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9816 N BEACH ST | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762446184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177412020 | ||||||||
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| Practice Location | |||||||||
| Address1: | 616 E BAILEY BOSWELL RD STE 200 | ||||||||
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| City: | SAGINAW | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761313575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177412020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2021 | ||||||||
| LastUpdateDate: | 08/03/2021 | ||||||||
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| AuthorizedOfficialLastName: | COLVIN | ||||||||
| AuthorizedOfficialFirstName: | ANJONETTE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8177018775 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
| NPICertificationDate: | 08/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.