Provider Demographics
NPI:1366069833
Name:SULLIVAN, MEGAN RILEY (OD)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:RILEY
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5225 VERDE VALLEY LN APT 161
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-7950
Mailing Address - Country:US
Mailing Address - Phone:214-708-3907
Mailing Address - Fax:
Practice Address - Street 1:1514 E BELT LINE RD
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-6369
Practice Address - Country:US
Practice Address - Phone:972-242-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9973T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty