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Organization
SPECIALEYES OPTICAL, LLC
Active
Organization
SPECIALEYES OPTICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERIC ALAN PACKWOOD MD (MEMBER)
(817) 529-9949
Entity
Organization
Contact information
Practice address
1106 ALEXIS CT, MANSFIELD, TX 76063-3338
(817) 529-9929
(817) 529-9927
Mailing address
321 S HENDERSON ST, FORT WORTH, TX 76104-1016
(817) 529-9929
(817) 529-9927
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
7210TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
018440004
—
TX
05
—
145291402
—
TX
05
—
166926901
—
TX
05
—
207716601
—
TX
05
—
287401803
—
TX
05
—
294486001
—
TX
05
—
323588905
—
TX
Enumeration date
08/22/2016
Last updated
08/22/2016
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