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Organization
PROSPER EYE CARE PA
Active
Organization
PROSPER EYE CARE PA
Active
Other names
1st EyeCare
Organization subpart
No
Provider details
NPI number
Authorized official
WADE A. KONVALIN OD (OWNER)
(972) 347-2020
Entity
Organization
Contact information
Practice address
221 N PRESTON RD, #B, PROSPER, TX 75078-8792
(972) 347-2020
(972) 347-2072
Mailing address
221 N PRESTON RD, #B, PROSPER, TX 75078-8792
(972) 347-2020
(972) 347-2072
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0062FG
BCBS ID#
—
01
—
6473620001
MEDICARE DME PTAN
TX
Enumeration date
08/31/2006
Last updated
06/09/2011
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