Provider Demographics
NPI:1528395993
Name:TEXAS RETINA INSTITUTE PA
Entity Type:Organization
Organization Name:TEXAS RETINA INSTITUTE PA
Other - Org Name:TEXAS RETINA INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:DJAFARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-651-2201
Mailing Address - Street 1:4010 SANDY BROOK DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-1516
Mailing Address - Country:US
Mailing Address - Phone:512-651-2201
Mailing Address - Fax:512-651-2207
Practice Address - Street 1:4010 SANDY BROOK DR
Practice Address - Street 2:SUITE 105
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1516
Practice Address - Country:US
Practice Address - Phone:512-651-2201
Practice Address - Fax:512-651-2207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9977207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty