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Organization
SOUTHWEST FAMILY EYE HEALTH CENTER, PLLC
Active
Organization
SOUTHWEST FAMILY EYE HEALTH CENTER, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEREMY E LOY O.D. (OPTOMETRIST)
(817) 885-7951
Entity
Organization
Contact information
Practice address
1101 W ROSEDALE ST, SUITE A, FORT WORTH, TX 76104-4425
(817) 885-7951
(817) 885-7953
Mailing address
1101 W ROSEDALE ST, SUITE A, FORT WORTH, TX 76104-4425
(817) 885-7951
(817) 885-7953
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
152WC0802X
Corneal and Contact Management Optometrist
—
—
152WL0500X
Low Vision Rehabilitation Optometrist
—
—
152WP0200X
Pediatric Optometrist
—
—
152WS0006X
Sports Vision Optometrist
—
—
152WV0400X
Vision Therapy Optometrist
—
—
152WX0102X
Occupational Vision Optometrist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TXB163917
MEDICARE GROUP PTAN
TX
Enumeration date
09/20/2012
Last updated
08/20/2019
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