DR. SHANE LUCAS TIBILETTI (NPI# 1639721392) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639721392 |
| Entity Type | Individual |
| Full Name | DR. SHANE LUCAS TIBILETTI |
| Credential | OD |
| Practice Address |
1101 Melbourne Rd # 217 Hurst TX 76053-6205 |
| Practice Telephone | 8172840798 |
| Mailing Telephone | 8172840798 |
| Enumeration Date | 2019-07-12 |
| Last Update Date | 2019-07-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | 9738T | TX | Eye and Vision Services Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2301 Porter Creek Dr # 217, Fort Worth, TX 761772336 | 8178477747 |
| Street Address |
1101 MELBOURNE RD # 217 |
| City | HURST |
| State | TX |
| Zip Code | 76053-6205 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518449933 | Areli Nunez | Physical Therapy Assistant | 304 Willow St, Hurst, TX 76053 | 2018-09-01 |
| 1043737778 | Sarah Renee Sarmiento | Occupational Therapy Assistant | 305 Ne Loop 820 Suite 209, Hurst, TX 76053 | 2017-08-23 |
| 1689026676 | Knee Coaster, LLC | Durable Medical Equipment & Medical Supplies | 1675 Sotogrande Blvd, 202, Hurst, TX 76053 | 2016-07-01 |
| 1053769836 | National Vision, Inc. | Technician/Technologist | 732 West Pipeline Rd, Hurst, TX 76053 | 2016-06-02 |
| 1902269038 | Martha De La Cruz-rodriguez | Specialist/Technologist | 305 Ne Loop 820 Business, Tower 1 Suite 200, Hurst, TX 76053 | 2016-04-05 |
| 1427420249 | Carol R. Wadsworth | Psychologist | 700 Ne Loop 820 Ste 200a, Hurst, TX 76053 | 2015-10-21 |
| 1972984623 | Sara Khalid Mahmood | Dentist | 800 Forest Oaks Ln Ste A, Hurst, TX 76053 | 2015-06-17 |
| 1306230073 | Sachenka Rivas | Speech-Language Pathologist | 305 Ne Loop 820,business Tower 1, Suite 200, Hurst, TX 76053 | 2015-03-20 |
| 1760873954 | Marcy Ann Fuentes | Occupational Therapy Assistant | 305 Ne Loop 820; Business Tower 1, Suite 200, Hurst, TX 76053 | 2015-02-10 |
| 1588062632 | Carolina Talancon | Specialist/Technologist | 305 Ne Loop 820;, Business Tower 1, Suite 200;, Hurst, TX 76053 | 2014-12-05 |
| Find all providers in zip 76053 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356986111 | Kami K Nguyen | Optometrist | 732 W Pipeline Rd, Hurst, TX 76053-4928 | 2019-11-15 |
| 1639728603 | Kirsten Bevan Fowler | Optometrist | 1101 Melbourne Rd Ste 3091, Hurst, TX 76053-6205 | 2019-09-11 |
| 1558923441 | Daniel Max & Marcandrea LLC | Optometrist | 1316 Precinct Line Rd, Hurst, TX 76053-3865 | 2019-07-01 |
| 1104379569 | Viren Choksi | Optometrist | 751 Mid Cities Blvd, Hurst, TX 76054-2748 | 2016-08-02 |
| 1881047918 | D'laine N Heisterkamp | Optometrist | 1872 Norwood Dr Ste 200, Hurst, TX 76054-7018 | 2016-07-13 |
| 1265787337 | Sarah Michele Talbott | Optometrist | 2817 Hurstview Dr., Hurst, TX 76054 | 2012-07-16 |
| 1407068521 | John Reddy Jr. | Optometrist | 1428 W Pipeline Rd, Hurst, TX 76053-4629 | 2007-05-03 |
| 1083767347 | Stephen Wayne Ference | Optometrist | 1101 Melbourne No East Mall, Suite 5060, Hurst, TX 76053 | 2007-01-19 |
| 1568510022 | Robert L Jones | Optometrist | 1101 Melbourne Rd Ste 3002, Hurst, TX 76053-6230 | 2007-01-08 |
| 1548326051 | Ference and Associates | Optometrist | 1101 Melbourne N Eastmall, #5060, Hurst, TX 76053 | 2006-12-29 |
| Find all providers in HURST | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.