1699052407 NPI number — AMARILLO FAMILY EYECARE, PC

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 1699052407 NPI number — AMARILLO FAMILY EYECARE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMARILLO FAMILY EYECARE, PC
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:
1699052407
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2921 I-40 W
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
AMARILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79109-1616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-322-3937
Provider Business Mailing Address Fax Number:
806-322-2220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2921 I-40 W
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79109-1616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-322-3937
Provider Business Practice Location Address Fax Number:
806-322-2220
Provider Enumeration Date:
11/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
WEIR
Authorized Official First Name:
MACKENZIE
Authorized Official Middle Name:
HILL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
806-322-3937

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: TXB165317 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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