1184796831 NPI number — DIAMOND K EYECARE INC

Table of content: (NPI 1184796831)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184796831 NPI number — DIAMOND K EYECARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIAMOND K EYECARE INC
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:
1184796831
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6102 FM 3009
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
SCHERTZ
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-651-3926
Provider Business Mailing Address Fax Number:
210-651-7494

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6102 FM 3009
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SCHERTZ
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-651-3926
Provider Business Practice Location Address Fax Number:
210-651-7494
Provider Enumeration Date:
11/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KLUFAS
Authorized Official First Name:
ROMAN
Authorized Official Middle Name:
YAREMA
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
210-651-3926

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: 0062FF . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0007196758 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 175572001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 178891551107 . This is a "HUMANA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".