1528187721 NPI number — MR. BORIS SAFIR

Table of content: MR. BORIS SAFIR (NPI 1528187721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528187721 NPI number — MR. BORIS SAFIR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAFIR
Provider First Name:
BORIS
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

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:
1528187721
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8989 SKILLMAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75243-8213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-341-2023
Provider Business Mailing Address Fax Number:
214-341-2024

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8989 SKILLMAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75243-8213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-341-2023
Provider Business Practice Location Address Fax Number:
214-341-2024
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 156FC0800X , with the licence number:  DR3723 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 156FX1800X , with the licence number: DR3722 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 019748501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18099 . This is a "DAVIS VISION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 752124243 . This is a "HEALTH SMART" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 918255 . This is a "BLOCK VISION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 752124243 . This is a "VSP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 27088 . This is a "SPECTERA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 752124243 . This is a "SUPERIOR VISION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: TX3723 . This is a "EYEMED" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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