Provider Demographics
NPI:1205016466
Name:EYE SPECIALISTS AND LASER CENTER OF TEXAS
Entity Type:Organization
Organization Name:EYE SPECIALISTS AND LASER CENTER OF TEXAS
Other - Org Name:EYE AND LASER SPECIALISTS OF TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
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:817-336-4401
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:972-899-8072
Practice Address - Street 1:1650 W ROSEDALE ST
Practice Address - Street 2:SUITE 202
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7400
Practice Address - Country:US
Practice Address - Phone:817-336-4401
Practice Address - Fax:817-335-2012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2903207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H50365Medicare UPIN
TX00Y873Medicare PIN