1427189968 NPI number — OPHTHALMOLOGY CONSULTANTS PA

Table of content: DR. NOURA ISABELLE KHAYAT PSY.D (NPI 1245731330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427189968 NPI number — OPHTHALMOLOGY CONSULTANTS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPHTHALMOLOGY CONSULTANTS 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:
1427189968
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3200 N MACARTHUR BLVD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75062-4453
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-258-7979
Provider Business Mailing Address Fax Number:
972-570-5502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3200 N MACARTHUR BLVD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
IRVING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75062-4453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-258-7979
Provider Business Practice Location Address Fax Number:
972-570-5502
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOODY
Authorized Official First Name:
EVERETT
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
972-258-7979

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 081759502 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00656N . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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