| Mansfield Vision Center Llc | |
|
990 Highway 287 N Ste 109 Mansfield TX 76063-2611 | |
| (817) 453-4682 | |
| Not Available |
| Full Name | Mansfield Vision Center Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 990 Highway 287 N Ste 109, Mansfield, Texas |
| Authorized Official Name and Position | Kyle Cooke (OWNER) |
| Authorized Official Contact | 8174534682 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mansfield Vision Center Llc 990 Highway 287 N Ste 109 Mansfield TX 76063-2611 Ph: (817) 453-4682 | Mansfield Vision Center Llc 990 Highway 287 N Ste 109 Mansfield TX 76063-2611 Ph: (817) 453-4682 |
| NPI Number | 1407020985 |
|---|---|
| Provider Enumeration Date | 04/16/2008 |
| Last Update Date | 04/18/2012 |
| Medicare PECOS PAC ID | 7113187691 |
|---|---|
| Medicare Enrollment ID | O20120320000642 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407020985 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 4960TG (Texas) | Primary |
| Provider Name | Douglas N Martin |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1457468597 PECOS PAC ID: 3476555079 Enrollment ID: I20070212000198 |
| Provider Name | Kyle A Cooke |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1265501332 PECOS PAC ID: 9638339112 Enrollment ID: I20120320000682 |
| Provider Name | Johnny T Phan |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1700268448 PECOS PAC ID: 0749595858 Enrollment ID: I20150819007304 |
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