Provider Demographics
NPI:1225202633
Name:CONTEMPORARY EYECARE, PA
Entity type:Organization
Organization Name:CONTEMPORARY EYECARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:QUYEN
Authorized Official - Middle Name:THUY
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-964-1461
Mailing Address - Street 1:1601 VILLAGE PKWY
Mailing Address - Street 2:SUITE 160
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-3226
Mailing Address - Country:US
Mailing Address - Phone:972-317-0831
Mailing Address - Fax:972-317-1360
Practice Address - Street 1:1601 VILLAGE PKWY
Practice Address - Street 2:SUITE 160
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75077-3226
Practice Address - Country:US
Practice Address - Phone:972-317-0831
Practice Address - Fax:972-317-1360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6501TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F2108Medicare PIN
TXV07919Medicare UPIN