Organization
FORT WORTH EYE CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAN LAM OD (OWNER)
(832) 518-6494
Entity
Organization
Contact information
Practice address
5329 SYCAMORE SCHOOL RD, SUITE 113, FORT WORTH, TX 76123
(832) 518-6494
Mailing address
218 FORESTRIDGE DR, MANSFIELD, TX 76063-8805
(832) 518-6494
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
152WC0802X
Corneal and Contact Management Optometrist
—
—
152WP0200X
Pediatric Optometrist
—
—
261Q00000X
Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
390684401
—
TX
01
—
A35198
EYEMED
—
Enumeration date
12/04/2020
Last updated
12/04/2020
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