Provider Demographics
NPI:1093872848
Name:TEXAS SPECTACLES LLC
Entity Type:Organization
Organization Name:TEXAS SPECTACLES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER,PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:T
Authorized Official - Last Name:KAVANAGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-379-3937
Mailing Address - Street 1:PO BOX 576
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78292-0576
Mailing Address - Country:US
Mailing Address - Phone:830-379-3937
Mailing Address - Fax:830-303-2367
Practice Address - Street 1:1551 WALNUT AVENUE
Practice Address - Street 2:STE 25
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130
Practice Address - Country:US
Practice Address - Phone:830-379-3937
Practice Address - Fax:830-303-2367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1354207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherEIN