Basic Information
| Provider Information | |||||||||
| NPI: | 1740494269 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ABBA EYE CARE PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 E CAMPBELL RD STE 108 | ||||||||
| Address2: | |||||||||
| City: | RICHARDSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750811963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147418183 | ||||||||
| FaxNumber: | 7192190411 | ||||||||
| Practice Location | |||||||||
| Address1: | 1650 W US HIGHWAY 50 | ||||||||
| Address2: | |||||||||
| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810081613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195421222 | ||||||||
| FaxNumber: | 7195463940 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 01/11/2021 | ||||||||
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| AuthorizedOfficialLastName: | MEYER | ||||||||
| AuthorizedOfficialFirstName: | MARCUS | ||||||||
| AuthorizedOfficialMiddleName: | JOHN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7192193819 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| NPICertificationDate: | 01/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 04015491 | 05 | CO | MEDICAID |