Provider Demographics
NPI:1043519556
Name:OPTIMEYES OPTOMETRY, PLLC
Entity type:Organization
Organization Name:OPTIMEYES OPTOMETRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANILOM
Authorized Official - Middle Name:JULIE
Authorized Official - Last Name:DOUANGPHILA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:214-383-7600
Mailing Address - Street 1:806 S ALLEN HEIGHTS DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-1875
Mailing Address - Country:US
Mailing Address - Phone:214-383-7600
Mailing Address - Fax:214-383-7652
Practice Address - Street 1:806 S ALLEN HEIGHTS DR
Practice Address - Street 2:SUITE 300
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-1875
Practice Address - Country:US
Practice Address - Phone:214-383-7600
Practice Address - Fax:214-383-7652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-23
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7332TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L6549Medicare PIN