OrganizationActive
Idea to Grow
NPI 1003411489 · Eyewear Supplier · Grand Prairie, TX
Provider details
- NPI number
- 1003411489
- Entity type
- Organization
- Primary specialty
- Eyewear SupplierSuppliers
- Organization subpart
- No
- Authorized official
- Jacke Bennett, Credentialing Manager(561) 612-4531
Specialties & taxonomies
Suppliers
Profile Score
Established profile(63/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
5 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1050 Mayfield Rd Ste 100
Grand Prairie, TX 75052-6043
Phone: (469) 865-1380
Fax: (561) 828-8367
Street-level locationGet directions
Mailing address
1050 Mayfield Rd Ste 100
Grand Prairie, TX 75052-6043
Registry dates
- Enumerated
- 2020-12-02
- Last updated
- 2021-02-19
- Certified
- 2021-02-19
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.