1063513794 NPI number — OPHTHALMIC CONSULTANTS OF TEXAS P.A.

Table of content: (NPI 1063513794)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063513794 NPI number — OPHTHALMIC CONSULTANTS OF TEXAS P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPHTHALMIC CONSULTANTS OF TEXAS P.A.
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:
1063513794
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4830
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDINBURG
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78540-4830
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
569-631-8875
Provider Business Mailing Address Fax Number:
956-265-1048

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1205 ED CAREY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARLINGEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78550-9207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-423-2100
Provider Business Practice Location Address Fax Number:
956-682-6280
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALEZ
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
HUGO
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
956-631-8875

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  E51458 , 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: 095075003 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com