Provider Demographics
NPI:1407930258
Name:CONSOLIDATED OPTICALS OF TEXAS
Entity Type:Organization
Organization Name:CONSOLIDATED OPTICALS OF TEXAS
Other - Org Name:TSO OF KILLEEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-778-9100
Mailing Address - Street 1:2806 S W S YOUNG DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-2010
Mailing Address - Country:US
Mailing Address - Phone:254-634-4800
Mailing Address - Fax:254-634-4142
Practice Address - Street 1:2806 S W S YOUNG DR
Practice Address - Street 2:SUITE A
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-2010
Practice Address - Country:US
Practice Address - Phone:254-634-4800
Practice Address - Fax:254-634-4142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0935173-01Medicaid