1114185089 NPI number — LARRY TARRANT O.D.

Table of content: KEITH PETER AMEYAW MD (NPI 1427611748)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114185089 NPI number — LARRY TARRANT O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LARRY TARRANT 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:
1114185089
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 W US HIGHWAY 80
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
FORNEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-551-2000
Provider Business Mailing Address Fax Number:
972-551-2011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 W MOORE AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
TERRELL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75160-2346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-551-2000
Provider Business Practice Location Address Fax Number:
972-551-2011
Provider Enumeration Date:
05/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
TARRANT
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
972-551-2000

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 163659901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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