Pediatric Eyecare of North Texas, PLLC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

Legal business name

PEDIATRIC EYECARE OF NORTH TEXAS, PLLC

Practice address

3200 N Macarthur Blvd Ste 200
Irving, TX 75062-4404

Phone

(972) 258-7979

Fax

(972) 570-5502

NPI assigned

Jul 28, 2023

Organization subpart

No

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

Authorized official

Name

Alicia Surratt

Title

Credentialing Coordinator

Phone

(972) 258-7979

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 7

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

• Anastasia Alex, MD

  • Ophthalmology Physician
  • Irving, TX
  • NPI 1497109375

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Hana Alsoudi, OD

  • Optometrist
  • Irving, TX
  • NPI 1851282818
  Medicare reassignment Care Compare group NPD
• Trisha Sofia Galicia Emborgo

  • Ophthalmology Physician
  • Irving, TX
  • NPI 1578198115
  Medicare reassignment Care Compare group NPD
• Kartik Sampath Kumar, M.D.

  • Ophthalmology Physician
  • Irving, TX
  • NPI 1699972364
  Medicare reassignment Care Compare group NPD
• Mary Colleen Walters, O.D.

  • Optometrist
  • Irving, TX
  • NPI 1194750406
  Medicare reassignment Care Compare group NPD
• Joanne Ashley Mai, OD

  • Optometrist
  • Arlington, TX
  • NPI 1669304994
  NPD
• Delaram Mostafavi, DDS

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Irving, TX
  • NPI 1730793555
  NPD (past)

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

{
    "created_epoch": "1690502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690502400000",
    "number": "1629759089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 N MACARTHUR BLVD STE 200",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750624404",
            "telephone_number": "972-258-7979",
            "fax_number": "972-570-5502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 N MACARTHUR BLVD STE 200",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750624404",
            "telephone_number": "972-258-7979",
            "fax_number": "972-570-5502"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4112 W 15th St Ste 201",
            "address_purpose": "LOCATION",
            "city": "Plano",
            "state": "TX",
            "postal_code": "750935858",
            "country_code": "US",
            "telephone_number": "972-258-7979",
            "fax_number": "972-570-5502",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2261 Brookhollow Plaza Dr Ste 209",
            "address_purpose": "LOCATION",
            "city": "Arlington",
            "state": "TX",
            "postal_code": "760067430",
            "country_code": "US",
            "telephone_number": "972-258-7979",
            "fax_number": "972-570-5502",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PEDIATRIC EYECARE OF NORTH TEXAS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-28",
        "last_updated": "2023-07-28",
        "certification_date": "2023-07-28",
        "status": "A",
        "authorized_official_last_name": "SURRATT",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "972-258-7979"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207WX0110X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology, Pediatric Ophthalmology and Strabismus Specialist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaitlin Peatross
• Kathleen Marie Pedersen, M.D.
• Pediatria Healthcare, LLC
• Pediatric Dental Associates of Las Colinas
• Pediatric Diagnostic Services, PA
• Pediatric Health Specialists, Inc
• Pediatric Speech Stars, PLLC
• Pediatrics & General Practice, PLLC
• Tiffany N Peek
• Shatyra B Peevy

• Ophthalmology Physician in Irving, TX
• Providers in Irving, TX by specialty
• Ophthalmology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2023; 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.