Provider Demographics
NPI:1356474050
Name:OPHTHALMIC PARTNERS , PA
Entity Type:Organization
Organization Name:OPHTHALMIC PARTNERS , PA
Other - Org Name:OPHTHALMOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:FLOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-332-2020
Mailing Address - Street 1:1201 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-4413
Mailing Address - Country:US
Mailing Address - Phone:817-332-2020
Mailing Address - Fax:817-332-4797
Practice Address - Street 1:1201 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-4413
Practice Address - Country:US
Practice Address - Phone:817-332-2020
Practice Address - Fax:817-332-4797
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPHTHALMIC PARTNERS , PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-13
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137346609Medicaid
TX0002AHOtherBCBS
TX0002AHOtherBCBS
TXCD4664Medicare PIN