NPI 1003411489

Idea to Grow

Organisation Eyewear Supplier Grand Prairie, TX

Practice location

Address: 1050 Mayfield Rd STE 100, Grand Prairie, TX 75052-6043
Phone: (469) 865-1380
Fax: (561) 828-8367

Authorised official

Name: Jacke Bennett
Title: Credentialing Manager
Phone: (561) 612-4531

Registered specialties

Eyewear Supplier Primary

Suppliers Taxonomy 332H00000X

Other Eyewear Supplier providers in Texas →

Registry record

NPI: 1003411489
Entity type: Organization
NPI issued: 2 Dec 2020
Record last updated: 19 Feb 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.