1326265489 NPI number — LINDA FAIN HATTON OD, PA

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 1326265489 NPI number — LINDA FAIN HATTON OD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LINDA FAIN HATTON OD, 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:
6
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:
1326265489
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5330 E MOCKINGBIRD LN
Provider Second Line Business Mailing Address:
SUITE # 130
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75206-0940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-341-9955
Provider Business Mailing Address Fax Number:
214-348-4545

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5330 E MOCKINGBIRD LN
Provider Second Line Business Practice Location Address:
SUITE # 130
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75206-0940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-341-9955
Provider Business Practice Location Address Fax Number:
214-348-4545
Provider Enumeration Date:
04/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HATTON
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
FAIN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
214-341-9955

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4077TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: 6622TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0097FA . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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