1881060457 NPI number — PARAGON LASER & EYE SURGERY CENTER

Table of content: DR. BERRYLIN RAY MARTIN MANGIN PSY.D. (NPI 1306254586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881060457 NPI number — PARAGON LASER & EYE SURGERY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARAGON LASER & EYE SURGERY CENTER
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:
1881060457
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
902 W RANDOL MILL RD
Provider Second Line Business Mailing Address:
STE. 230
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76012-2572
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-277-6433
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
902 W RANDOL MILL RD
Provider Second Line Business Practice Location Address:
STE. 230
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76012-2572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-277-6433
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/18/2015

Additional Information

Authorized Official

Authorized Official Last Name:
FORD
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
TODD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
817-360-9570

Provider Taxonomy Codes

  • Taxonomy code: 261QS0132X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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