Provider Demographics
NPI:1174660260
Name:UNIVERSITY OF HOUSTON SYSTEM
Entity Type:Organization
Organization Name:UNIVERSITY OF HOUSTON SYSTEM
Other - Org Name:CEDAR SPRINGS EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:W
Authorized Official - Last Name:DELOACH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:214-528-7354
Mailing Address - Street 1:2525 LUCAS DR
Mailing Address - Street 2:BUILDING 3
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-1804
Mailing Address - Country:US
Mailing Address - Phone:214-528-7354
Mailing Address - Fax:214-528-7387
Practice Address - Street 1:2525 LUCAS DR
Practice Address - Street 2:BUILDING 3
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-1804
Practice Address - Country:US
Practice Address - Phone:214-528-7354
Practice Address - Fax:214-528-7387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112409105Medicaid
TX00395ZMedicare ID - Type UnspecifiedGROUP PROVIDER NUMBER