Organization
LEGACY VISION PA
Active
Parent organization
LEGACY VISION PA
Organization subpart
Yes
Provider details
NPI number
Legal business name
LEGACY VISION PA
Authorized official
TRISH E TODD ABOC (MANAGER)
(972) 208-5757
Entity
Organization
Contact information
Practice address
6909 COIT RD, SUITE 200, PLANO, TX 75024
(972) 208-5757
(972) 208-5548
Mailing address
6909 COIT RD, SUITE 200, PLANO, TX 75024
(972) 208-5757
(972) 208-5548
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
03489TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00825P
MEDICARE
TX
Enumeration date
01/18/2008
Last updated
06/15/2010
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