Provider Demographics
NPI:1013193804
Name:EYE SPECIALISTS AND LASER CENTER OF TEXAS
Entity Type:Organization
Organization Name:EYE SPECIALISTS AND LASER CENTER OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUBIR
Authorized Official - Middle Name:S
Authorized Official - Last Name:BHATIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-899-8070
Mailing Address - Street 1:370 W HWY 121
Mailing Address - Street 2:SUITE 105
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019
Mailing Address - Country:US
Mailing Address - Phone:972-899-8070
Mailing Address - Fax:
Practice Address - Street 1:370 W HWY 121
Practice Address - Street 2:SUITE 105
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019
Practice Address - Country:US
Practice Address - Phone:972-899-8070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2903207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y875Medicare PIN
H50365Medicare UPIN