Provider Demographics
NPI:1609072628
Name:TRICON EYE CARE CENTER, PA
Entity type:Organization
Organization Name:TRICON EYE CARE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THEM
Authorized Official - Middle Name:LE
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-467-8100
Mailing Address - Street 1:6300 STONEWOOD DR
Mailing Address - Street 2:304
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-5280
Mailing Address - Country:US
Mailing Address - Phone:469-467-8100
Mailing Address - Fax:469-467-4556
Practice Address - Street 1:6300 STONEWOOD DR
Practice Address - Street 2:304
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-5280
Practice Address - Country:US
Practice Address - Phone:469-467-8100
Practice Address - Fax:469-467-4556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7916174400000X
207W00000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5552704OtherFIREST HEALTH PROVIDER #
TX8R1300OtherBCBS PROVIDER NUMBER
TX3723044OtherAETNA PROVIDER NUMBER
TX5801951OtherCIGNA PROVIDER NUMBER
TX8R1300OtherBCBS PROVIDER NUMBER
TX=========OtherTAX ID NUMBER
TXI12509Medicare UPIN
TX169375601Medicaid
TX5476450001Medicare NSC