Provider Demographics
NPI:1063421584
Name:HELBERT GREEN, CAROLYN LEE
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:LEE
Last Name:HELBERT GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COLLEYVILLE
Other - Middle Name:VISION
Other - Last Name:ASSOCIATES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1213 HALL JOHNSON RD
Mailing Address - Street 2:STE 300
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-5847
Mailing Address - Country:US
Mailing Address - Phone:817-428-0400
Mailing Address - Fax:817-428-0457
Practice Address - Street 1:1213 HALL JOHNSON RD
Practice Address - Street 2:SUITE # 300
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-5847
Practice Address - Country:US
Practice Address - Phone:817-428-0400
Practice Address - Fax:817-428-0457
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03802TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX03802TGOtherOPTOMETRY BOARD LICENSE #
TX1336326966OtherGROUP NPI NUMBER
TXMH0879063OtherDHE
TXW0122304OtherDPS
TXMH0879063OtherDHE
TX03802TGOtherOPTOMETRY BOARD LICENSE #