1295863454 NPI number — I ADVANTAGE EYECARE, PA

Table of content: (NPI 1295863454)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295863454 NPI number — I ADVANTAGE EYECARE, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
I ADVANTAGE EYECARE, PA
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:
1295863454
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6509 PRECINCT LINE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH RICHLAND HILLS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76182-4313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-788-2020
Provider Business Mailing Address Fax Number:
817-788-2023

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6509 PRECINCT LINE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH RICHLAND HILLS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76182-4313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-788-2020
Provider Business Practice Location Address Fax Number:
817-788-2023
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SCHWARTZ
Authorized Official First Name:
ARLENE
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
817-788-2020

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: DA7538 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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