Provider Demographics
NPI:1336185727
Name:EYECARE & EYEWEAR INC.
Entity type:Organization
Organization Name:EYECARE & EYEWEAR INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELBY
Authorized Official - Middle Name:ATKINS
Authorized Official - Last Name:TRUSTY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:940-891-3937
Mailing Address - Street 1:3111 UNICORN LAKE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-0118
Mailing Address - Country:US
Mailing Address - Phone:940-891-3937
Mailing Address - Fax:940-591-8368
Practice Address - Street 1:3111 UNICORN LAKE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-0118
Practice Address - Country:US
Practice Address - Phone:940-891-3937
Practice Address - Fax:940-591-8368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03995TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019328601Medicaid
TX3995TGOtherOD LICENSE
TX0178390001OtherMEDICARE - PALMETTO
TX00520NMedicare PIN
TXT86250Medicare UPIN
TX3995TGOtherOD LICENSE