Provider Demographics
NPI:1225292741
Name:MICHAEL DELLIS, O.D., P.C.
Entity Type:Organization
Organization Name:MICHAEL DELLIS, O.D., P.C.
Other - Org Name:DR. MICHAEL DELLIS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:DELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:254-582-2351
Mailing Address - Street 1:PO BOX 779
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:76645-0779
Mailing Address - Country:US
Mailing Address - Phone:254-582-2351
Mailing Address - Fax:254-582-7017
Practice Address - Street 1:1400 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:TX
Practice Address - Zip Code:76645-2676
Practice Address - Country:US
Practice Address - Phone:254-582-2351
Practice Address - Fax:254-582-7017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2348T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A3869OtherMEDICARE GROUP PTAN
000E94DOtherBLUE CROSS BLUE SHIELD
TX093480401Medicaid
410019703OtherRAILROAD MEDICARE
TXT12982Medicare PIN
00E94DMedicare UPIN
TX6183280001Medicare NSC