Provider Demographics
NPI:1063588861
Name:DESOTO EYECARE ASSOCIATES PROFESSIONAL ASSOCIATION
Entity type:Organization
Organization Name:DESOTO EYECARE ASSOCIATES PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:QUY
Authorized Official - Last Name:CAO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-459-2587
Mailing Address - Street 1:2403 S STEMMONS FWY
Mailing Address - Street 2:STE. 113
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-8976
Mailing Address - Country:US
Mailing Address - Phone:972-459-2587
Mailing Address - Fax:972-459-2948
Practice Address - Street 1:2403 S STEMMONS FWY
Practice Address - Street 2:STE. 113
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-8976
Practice Address - Country:US
Practice Address - Phone:972-459-2587
Practice Address - Fax:972-459-2948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6827TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty