Organization
IDEA TO GROW, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE BENNETT (CREDENTIALING MANAGER)
(561) 612-4531
Entity
Organization
Contact information
Practice address
1050 MAYFIELD RD STE 100, GRAND PRAIRIE, TX 75052-6043
(561) 275-2020
(561) 828-8367
Mailing address
1050 MAYFIELD RD STE 100, GRAND PRAIRIE, TX 75052-6043
(561) 275-2020
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
332H00000X
Eyewear Supplier
—
—
Other
Enumeration date
12/09/2020
Last updated
02/19/2021
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