Individual
MR. ELVIN W FENTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
751 MID CITIES BLVD, HURST, TX 76054-2748
(817) 656-2020
(817) 656-5908
Mailing address
1950 OLD GALLOWS RD STE 520, VIENNA, VA 22182-3970
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
5241
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0193336-01
—
TX
05
—
134244722
—
AR
01
—
83324E
BCBS PROVIDER
TX
01
—
97883
AR BCBS PROVIDER NUMBER
AR
Enumeration date
08/23/2005
Last updated
04/07/2022
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