NPIMap

Organization Active NPI

Optical Boutique and Eyecare

  • Optometrist
  • Desoto, TX
National Provider Identifier
1407472376
Registry record updated Nov 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
OPTICAL BOUTIQUE AND EYECARE
Practice address
1233 E Pleasant Run Rd Ste a
Desoto, TX 75115-4200
Phone
(972) 223-2020
Fax
(972) 228-1860
NPI assigned
Jun 17, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2020

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

Authorized official

Name
Dr. Danielle Gloster, O.D.
Title
Owner
Phone
(972) 223-2020

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X Primary
Corneal and Contact Management OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WC0802X
Optometric Assistant TechnicianGroup: 193200000X MULTI-SPECIALTY GROUP 156FX1201X
Optometric TechnicianGroup: 193200000X MULTI-SPECIALTY GROUP 156FX1202X
OpticianGroup: 193200000X MULTI-SPECIALTY GROUP 156FX1800X

Addresses

Primary practice location

1233 E Pleasant Run Rd Ste a
Desoto, TX 75115-4200

Mailing address

PO Box 444
Lancaster, TX 75146-0444
Phone (972) 223-2020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201209002419 TX Part B Supplier - Clinic/Group Practice 7618389073 Receives reassigned benefits from 2 practitioners
Practice locations: Desoto, TX

National Provider Directory

National Provider Directory

Locations

1233 E Pleasant Run Rd
#A
Desoto, TX 75115
Phone (972) 223-2020

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1592352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604880000000",
    "number": "1407472376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 444",
            "city": "LANCASTER",
            "state": "TX",
            "postal_code": "751460444",
            "telephone_number": "972-223-2020",
            "fax_number": "972-228-1860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1233 E PLEASANT RUN RD STE A",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751154200",
            "telephone_number": "972-223-2020",
            "fax_number": "972-228-1860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTICAL BOUTIQUE AND EYECARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-17",
        "last_updated": "2020-11-09",
        "certification_date": "2020-11-09",
        "status": "A",
        "authorized_official_last_name": "GLOSTER",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-223-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "156FX1201X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician/Technologist, Optometric Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "156FX1202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician/Technologist, Optometric Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "156FX1800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Desoto, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.