Provider Demographics
NPI:1558319384
Name:EYES OF TEXAS, LLP
Entity Type:Organization
Organization Name:EYES OF TEXAS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-367-7241
Mailing Address - Street 1:PO BOX 12130
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79768
Mailing Address - Country:US
Mailing Address - Phone:432-367-7241
Mailing Address - Fax:432-550-3427
Practice Address - Street 1:3527 B1 BILLY HEXT ROAD
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765
Practice Address - Country:US
Practice Address - Phone:432-367-7241
Practice Address - Fax:432-550-3427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1095259-03Medicaid
00359RMedicare UPIN