Provider Demographics
NPI:1154583706
Name:TEXAS VISION CARE
Entity type:Organization
Organization Name:TEXAS VISION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:HANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-557-3952
Mailing Address - Street 1:2905 MEDLIN DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2330
Mailing Address - Country:US
Mailing Address - Phone:817-557-3952
Mailing Address - Fax:817-557-1030
Practice Address - Street 1:2905 MEDLIN DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2330
Practice Address - Country:US
Practice Address - Phone:817-557-3952
Practice Address - Fax:817-557-1030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3637TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU36385Medicare UPIN
TXU82426Medicare UPIN