Provider Demographics
NPI:1174597868
Name:CHILDRENS EYE CARE OF NORTH TEXAS PA
Entity type:Organization
Organization Name:CHILDRENS EYE CARE OF NORTH TEXAS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:LEFFLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-985-1233
Mailing Address - Street 1:4112 W 15TH ST
Mailing Address - Street 2:STE 201
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093
Mailing Address - Country:US
Mailing Address - Phone:972-985-1233
Mailing Address - Fax:972-985-9939
Practice Address - Street 1:4112 W 15TH ST
Practice Address - Street 2:STE 201
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093
Practice Address - Country:US
Practice Address - Phone:972-985-1233
Practice Address - Fax:972-985-9939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8617207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00HS42Medicare ID - Type Unspecified
B24312Medicare UPIN