Basic Information
Provider Information
NPI: 1972891729
EntityType: 2
ReplacementNPI:  
OrganizationName: WEST PLANO EYE CARE PA
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: FIRST EYE CARE WEST PLANO
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3405 MIDWAY RD 421
Address2:  
City: PLANO
State: TX
PostalCode: 750938144
CountryCode: US
TelephoneNumber: 9728012727
FaxNumber:  
Practice Location
Address1: 3405 MIDWAY RD 421
Address2:  
City: PLANO
State: TX
PostalCode: 750938144
CountryCode: US
TelephoneNumber: 9728012727
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/14/2011
LastUpdateDate: 08/17/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: BALLARD
AuthorizedOfficialFirstName: THOMAS
AuthorizedOfficialMiddleName: D
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 9729602020
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: OD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
152W00000X3442TGTXY193400000X SINGLE SPECIALTY GROUPEye and Vision Services ProvidersOptometrist 

No ID Information.


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