Elysian Eyecare PLLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

ELYSIAN EYECARE PLLC

Practice address

1971 Highway 287 N Ste 105
Mansfield, TX 76063-8983

Phone

(817) 453-7591

Fax

(817) 453-7715

NPI assigned

Mar 2, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Phuong Pham, OD

Title

Optometrist

Phone

(347) 279-1020

Specialties & licenses 1

Addresses

Other names 1

• Unique Vision Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614643200000",
    "number": "1013502004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1971 HIGHWAY 287 N STE 105",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760638983",
            "telephone_number": "817-453-7591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1971 HIGHWAY 287 N STE 105",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760638983",
            "telephone_number": "817-453-7591",
            "fax_number": "817-453-7715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELYSIAN EYECARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-02",
        "last_updated": "2021-03-02",
        "certification_date": "2021-03-02",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "PHUONG",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "347-279-1020",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Unique Vision",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinic/Center in Mansfield, TX
• Providers in Mansfield, TX by specialty
• Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.