Provider Demographics
NPI:1063822252
Name:STELLAR VISION CORPORATION
Entity type:Organization
Organization Name:STELLAR VISION CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPEUTIC OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:RAJAL
Authorized Official - Middle Name:
Authorized Official - Last Name:NOORALI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:469-417-9921
Mailing Address - Street 1:2608 MUSEUM WAY APT 3516
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-3085
Mailing Address - Country:US
Mailing Address - Phone:469-417-9921
Mailing Address - Fax:
Practice Address - Street 1:735 E HIGHWAY 377
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-2578
Practice Address - Country:US
Practice Address - Phone:817-964-3455
Practice Address - Fax:817-964-3465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-28
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty