Specialeyes Optical, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

7210TG Issued in TX

Legal business name

SPECIALEYES OPTICAL, LLC

Practice address

1106 Alexis CT
Mansfield, TX 76063-3338

Phone

(817) 529-9929

Fax

(817) 529-9927

NPI assigned

Aug 22, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Eric Alan Packwood, MD

Title

Member

Phone

(817) 529-9949

Specialties & licenses 1

Addresses

Other identifiers 7

Tax ID family

Specialeyes Optical LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• Special Eyes Optical, LLC

  • Optometrist
  • Carrollton, TX
  • NPI 1215462148
  NPD tax ID
• Specialeyes Optical, LLC

  • Optometrist
  • Keller, TX
  • NPI 1679028542
  NPD tax ID
• Specialeyes Optical, LLC

  • Optometrist
  • Denton, TX
  • NPI 1821564964
  NPD tax ID

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Alan Andrew Norman, MD

  • Ophthalmology Physician
  • Fort Worth, TX
  • NPI 1346219821
  NPD (past)
• Robert Wade Paschal III, O.D.

  • Optometrist
  • Port Arthur, TX
  • NPI 1457594277
  NPD (past)
• David F Skanchy

  • Pediatric Ophthalmology and Strabismus Specialist Physician
  • Fort Worth, TX
  • NPI 1649831462
  NPD (past)
• Sarah Madison Duff, MD

  • Pediatric Ophthalmology and Strabismus Specialist Physician
  • Louisville, KY
  • NPI 1417480153
  NPD (past)

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

{
    "created_epoch": "1471824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471824000000",
    "number": "1124573092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 S HENDERSON ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761041016",
            "telephone_number": "817-529-9929",
            "fax_number": "817-529-9927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1106 ALEXIS CT",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760633338",
            "telephone_number": "817-529-9929",
            "fax_number": "817-529-9927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECIALEYES OPTICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-22",
        "last_updated": "2016-08-22",
        "status": "A",
        "authorized_official_last_name": "PACKWOOD",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "817-529-9949",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "TX",
            "license": "7210TG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "166926901",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "145291402",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "018440004",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207716601",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "323588905",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "287401803",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "294486001",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Mansfield, TX
• Providers in Mansfield, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2016; 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.