Provider Demographics
NPI:1427189968
Name:OPHTHALMOLOGY CONSULTANTS PA
Entity Type:Organization
Organization Name:OPHTHALMOLOGY CONSULTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EVERETT
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-258-7979
Mailing Address - Street 1:3200 N MACARTHUR BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-4453
Mailing Address - Country:US
Mailing Address - Phone:972-258-7979
Mailing Address - Fax:972-570-5502
Practice Address - Street 1:3200 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-4453
Practice Address - Country:US
Practice Address - Phone:972-258-7979
Practice Address - Fax:972-570-5502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081759502Medicaid
TX00656NOtherBCBS
TX00656NMedicare ID - Type Unspecified
TX081759502Medicaid