Organization
CORSICANA ENVISION EYECARE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAX JERRY WORLEY O.D (OWNER)
(903) 872-5681
Entity
Organization
Contact information
Practice address
202 W 5TH AVE, CORSICANA, TX 75110-5202
(903) 872-5681
(903) 872-0603
Mailing address
202 W 5TH AVE, CORSICANA, TX 75110-5202
(903) 872-5681
(903) 872-0603
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1801TG
TX
152W00000X
Optometrist
6404-TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0930323-01
—
TX
Enumeration date
04/22/2013
Last updated
04/12/2022
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