1073843066 NPI number — ALJP VISION, PLLC

Table of content: (NPI 1073843066)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073843066 NPI number — ALJP VISION, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALJP VISION, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
INSIGHT EYE ASSOCIATES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073843066
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5310 N TARRANT PKWY
Provider Second Line Business Mailing Address:
STE 128
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76244-5386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-514-2114
Provider Business Mailing Address Fax Number:
817-514-2150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5310 N TARRANT PKWY
Provider Second Line Business Practice Location Address:
STE 128
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76244-5386
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-514-2114
Provider Business Practice Location Address Fax Number:
817-514-2150
Provider Enumeration Date:
01/13/2010

Additional Information

Authorized Official

Authorized Official Last Name:
PIERCE
Authorized Official First Name:
JORDAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OPTOMETRIST/MANAGING MEMBER
Authorized Official Telephone Number:
817-514-2114

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  7417TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152WC0802X , with the licence number: 7408TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 213985901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: TXB102634 . This is a "MEDICARE PART B PROVIDER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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