Provider Demographics
NPI:1902982135
Name:ADVANCED EYECARE
Entity Type:Organization
Organization Name:ADVANCED EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOOPER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:903-595-6592
Mailing Address - Street 1:1314 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2262
Mailing Address - Country:US
Mailing Address - Phone:903-595-6592
Mailing Address - Fax:903-593-5972
Practice Address - Street 1:1314 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2262
Practice Address - Country:US
Practice Address - Phone:903-595-6592
Practice Address - Fax:903-593-5972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0038FFOtherBLUE CROSS BLUE SHIELD GOVERNMENT
TX5451470001OtherCIGNA GOVERNMENT SERVICES
TX0038FFOtherBLUE CROSS BLUE SHIELD
TX172256301Medicaid
TX5451470001Medicare NSC
TX5451470001OtherCIGNA GOVERNMENT SERVICES
TXDD7640Medicare PIN