NPIMap

Organization Active NPI

Specialeyes Optical, LLC

  • Optometrist
  • Mansfield, TX
National Provider Identifier
1124573092
Registry record updated Aug 22, 2016
On this page

Key facts

NPPES NPI Registry
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
Last updated
Aug 22, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2016

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

Authorized official

Name
Dr. Eric Alan Packwood, MDNPI 1366414773
Title
Member
Phone
(817) 529-9949

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 7210TG TX Primary

Addresses

Primary practice location

1106 Alexis CT
Mansfield, TX 76063-3338

Mailing address

321 S Henderson St
Fort Worth, TX 76104-1016
Phone (817) 529-9929

National Provider Directory

National Provider Directory
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.

Locations

321 S Henderson St
Fort Worth, TX 76104
Phone (817) 529-9949

1106 Alexis Ct
Mansfield, TX 76063
Phone (817) 529-9949

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mansfield, TX

Sources for this page

  • 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.