Provider Demographics
NPI:1699140665
Name:DENTON EYEDOCTORS
Entity type:Organization
Organization Name:DENTON EYEDOCTORS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:940-293-1127
Mailing Address - Street 1:207 W HICKORY ST STE 102
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-4147
Mailing Address - Country:US
Mailing Address - Phone:940-293-1127
Mailing Address - Fax:866-722-4820
Practice Address - Street 1:207 W HICKORY ST STE 102
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4147
Practice Address - Country:US
Practice Address - Phone:940-293-1127
Practice Address - Fax:866-722-4820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4228T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX343154601Medicaid
TX343154601Medicaid