Special Eyes Optical, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

7210TG Issued in TX

Legal business name

SPECIAL EYES OPTICAL, LLC

Practice address

1509 W Hebron Pkwy
Suite 300
Carrollton, TX 75010-6336

Phone

(214) 390-7151

Fax

(214) 390-7152

NPI assigned

Apr 28, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Eriv Alan Packwood, MD

Title

Owner/Partner

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.

• Specialeyes Optical, LLC

  • Optometrist
  • Mansfield, TX
  • NPI 1124573092
  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

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

{
    "created_epoch": "1493337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493337600000",
    "number": "1215462148",
    "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": "817-529-9949",
            "fax_number": "817-529-9943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1509 W HEBRON PKWY",
            "address_2": "SUITE 300",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750106336",
            "telephone_number": "214-390-7151",
            "fax_number": "214-390-7152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECIAL EYES OPTICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-28",
        "last_updated": "2017-04-28",
        "status": "A",
        "authorized_official_last_name": "PACKWOOD",
        "authorized_official_first_name": "ERIV",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "OWNER/PARTNER",
        "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": "287401803",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207716601",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "294486001",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "018440004",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "323588905",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "145291402",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "166926901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2017; 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.