Provider Demographics
NPI:1992731285
Name:CORSICANNA EYE CARE, P.A.
Entity type:Organization
Organization Name:CORSICANNA EYE CARE, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:DENT
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-960-2020
Mailing Address - Street 1:400 N 15TH ST
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-4514
Mailing Address - Country:US
Mailing Address - Phone:903-872-2561
Mailing Address - Fax:903-872-5273
Practice Address - Street 1:400 N 15TH ST
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-4514
Practice Address - Country:US
Practice Address - Phone:903-872-2561
Practice Address - Fax:903-872-5273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3442TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F1064Medicare ID - Type Unspecified