Provider Demographics
NPI:1194900225
Name:ELITE EYECARE CENTER
Entity type:Organization
Organization Name:ELITE EYECARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANH
Authorized Official - Middle Name:T
Authorized Official - Last Name:VO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-222-2020
Mailing Address - Street 1:1712 N BEACH ST
Mailing Address - Street 2:
Mailing Address - City:HALTOM CITY
Mailing Address - State:TX
Mailing Address - Zip Code:76111-6618
Mailing Address - Country:US
Mailing Address - Phone:817-222-2020
Mailing Address - Fax:817-222-2020
Practice Address - Street 1:1712 N BEACH ST
Practice Address - Street 2:
Practice Address - City:HALTOM CITY
Practice Address - State:TX
Practice Address - Zip Code:76111-6618
Practice Address - Country:US
Practice Address - Phone:817-222-2020
Practice Address - Fax:817-222-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5466T332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU72278Medicare UPIN