Organization
LAVI VISION PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JULIA N TA O.D. (OPTOMETRIST/PRESIDENT)
(510) 300-5800
Entity
Organization
Contact information
Practice address
2325 W INTERSTATE 20, GRAND PRAIRIE, TX 75052-3927
(510) 300-5810
Mailing address
2934 PEGASUS CT, GRAND PRAIRIE, TX 75052-8042
(510) 300-5810
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
7696TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2871717
—
TX
01
—
TXB141982
MEDICARE PTAN
TX
Enumeration date
03/21/2012
Last updated
03/21/2012
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