Provider Demographics
NPI:1538784889
Name:PROVECTUS FAMILY EYE CARE
Entity type:Organization
Organization Name:PROVECTUS FAMILY EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:KHANG
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:469-237-0805
Mailing Address - Street 1:2605 BARTON CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-4357
Mailing Address - Country:US
Mailing Address - Phone:469-237-0805
Mailing Address - Fax:
Practice Address - Street 1:4800 S HULEN ST STE 147
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-1415
Practice Address - Country:US
Practice Address - Phone:817-769-8566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty