Provider Demographics
NPI:1699264507
Name:DENISON EYECARE CENTER, PLLC
Entity type:Organization
Organization Name:DENISON EYECARE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CLABORN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:580-920-5389
Mailing Address - Street 1:2515 W MORTON ST
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-1403
Mailing Address - Country:US
Mailing Address - Phone:903-465-1810
Mailing Address - Fax:903-465-1811
Practice Address - Street 1:2515 W MORTON ST
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-1403
Practice Address - Country:US
Practice Address - Phone:903-465-1810
Practice Address - Fax:903-465-1811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-07
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1801298492Medicaid