Provider Demographics
NPI:1477827400
Name:EUENE P SHOLDRA M. D. P.A
Entity Type:Organization
Organization Name:EUENE P SHOLDRA M. D. P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHOLDRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-596-5020
Mailing Address - Street 1:810 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-5365
Mailing Address - Country:US
Mailing Address - Phone:817-596-5020
Mailing Address - Fax:817-613-8890
Practice Address - Street 1:810 S .MAIN ST.
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5365
Practice Address - Country:US
Practice Address - Phone:817-596-5020
Practice Address - Fax:817-613-8890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9990207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034228901Medicaid
TXB26422Medicare UPIN