1568541712 NPI number — OPHTHALMIC PARTNERS, PA

Table of content: (NPI 1568541712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568541712 NPI number — OPHTHALMIC PARTNERS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPHTHALMIC PARTNERS, 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:
1568541712
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 SUMMIT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76102-4413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-332-2020
Provider Business Mailing Address Fax Number:
817-332-4797

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3906 HWY. 377
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
GRANBURY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-579-0100
Provider Business Practice Location Address Fax Number:
817-279-0699
Provider Enumeration Date:
11/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FLOWERS
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
817-332-2020

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 137346605 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 137346610 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 137346611 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0001AH . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com