Provider Demographics
NPI:1407837479
Name:THOMAS L HENDRIX, MD, PATRICIA B DEARMAN, MD, W THOMAS KITTLEMAN, MD,P
Entity Type:Organization
Organization Name:THOMAS L HENDRIX, MD, PATRICIA B DEARMAN, MD, W THOMAS KITTLEMAN, MD,P
Other - Org Name:EYE ASSOCIATES OF CENTRAL TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:HENDRIX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-352-7664
Mailing Address - Street 1:603 MALLARD LN
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:TX
Mailing Address - Zip Code:76574-1214
Mailing Address - Country:US
Mailing Address - Phone:512-352-7664
Mailing Address - Fax:512-365-5237
Practice Address - Street 1:603 MALLARD LN
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:TX
Practice Address - Zip Code:76574-1214
Practice Address - Country:US
Practice Address - Phone:512-352-7664
Practice Address - Fax:512-365-5237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127282503Medicaid
TX0938750001Medicare NSC
TX00D34NMedicare PIN