Provider Demographics
NPI:1780841411
Name:ACCENT OPTICAL PA
Entity type:Organization
Organization Name:ACCENT OPTICAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:B
Authorized Official - Last Name:MOSBACHER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:214-744-2020
Mailing Address - Street 1:1415 MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75202-4117
Mailing Address - Country:US
Mailing Address - Phone:214-744-2020
Mailing Address - Fax:214-744-0925
Practice Address - Street 1:1415 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75202-4117
Practice Address - Country:US
Practice Address - Phone:214-744-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3315T302F00000X
152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
No302F00000XManaged Care OrganizationsExclusive Provider OrganizationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093333503Medicaid
TX300318801Medicaid
TX093450702Medicaid