Organization
20/20 ICARE TYLER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LONG DO OD (PRESIDENT)
(817) 262-2145
Entity
Organization
Contact information
Practice address
4824 S BROADWAY AVE, TYLER, TX 75703-1312
(903) 581-2020
Mailing address
5836 SUNNY MEADOW LN, GRAND PRAIRIE, TX 75052-8782
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8143TG
TEXAS OPTOMETRY BOARD
TX
Enumeration date
08/07/2022
Last updated
08/07/2022
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