1699899781 NPI number — DALLAS EYE CARE ASSOCIATES PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699899781 NPI number — DALLAS EYE CARE ASSOCIATES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DALLAS EYE CARE ASSOCIATES 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:
DALLAS EYE CARE 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:
1699899781
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3900 E MEXICO AVE STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80210-3941
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-800-2078
Provider Business Mailing Address Fax Number:
303-800-2078

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 N GUN BARREL LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GUN BARREL CITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75156-3732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-784-0222
Provider Business Practice Location Address Fax Number:
817-417-0981
Provider Enumeration Date:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ELLISON
Authorized Official First Name:
CHRISTIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
720-524-1001

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 173901301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: CF8271 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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