Provider Demographics
NPI:1588934525
Name:THE EYE PHYSICIAN GROUP PLLC
Entity type:Organization
Organization Name:THE EYE PHYSICIAN GROUP PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANG
Authorized Official - Middle Name:
Authorized Official - Last Name:AN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-579-4646
Mailing Address - Street 1:204 S NURSERY RD
Mailing Address - Street 2:SUITE 168
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75060-3184
Mailing Address - Country:US
Mailing Address - Phone:972-579-4646
Mailing Address - Fax:972-579-0909
Practice Address - Street 1:204 S NURSERY RD
Practice Address - Street 2:SUITE 168
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75060-3184
Practice Address - Country:US
Practice Address - Phone:972-579-4646
Practice Address - Fax:972-579-0909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-09
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB155096Medicare PIN