Provider Demographics
NPI:1861618092
Name:COLLIN CREEK EYE CLINIC P.A
Entity type:Organization
Organization Name:COLLIN CREEK EYE CLINIC P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTNI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-596-3800
Mailing Address - Street 1:2821 W PARKER RD
Mailing Address - Street 2:SUITE1
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-7950
Mailing Address - Country:US
Mailing Address - Phone:972-596-3800
Mailing Address - Fax:
Practice Address - Street 1:2821 W PARKER RD
Practice Address - Street 2:SUITE1
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-7950
Practice Address - Country:US
Practice Address - Phone:972-596-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4757TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1169800001OtherNSC
TX0A4530Medicare PIN