1154545481 NPI number — BRYAN CAVE, O.D.

Table of content: (NPI 1154545481)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154545481 NPI number — BRYAN CAVE, O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRYAN CAVE, O.D.
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:
Provider Other Organization Name Type Code:
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:
1154545481
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5305 TRINITY BLVD
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
SNYDER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79549-6164
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-573-5571
Provider Business Mailing Address Fax Number:
325-573-6868

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5305 TRINITY BLVD
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
SNYDER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79549-6164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-573-5571
Provider Business Practice Location Address Fax Number:
325-573-6868
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CAVE
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
BRYAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
325-573-5571

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  3325T , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 540010583 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 093269120 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00E50A . This is a "BLUE CROSS BLUE SHIELD TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 110055102 . This is a "FIRST CARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 11390 . This is a "OPTICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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