Provider Demographics
NPI:1568541712
Name:OPHTHALMIC PARTNERS, PA
Entity Type:Organization
Organization Name:OPHTHALMIC PARTNERS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:FLOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-332-2020
Mailing Address - Street 1:1201 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-4413
Mailing Address - Country:US
Mailing Address - Phone:817-332-2020
Mailing Address - Fax:817-332-4797
Practice Address - Street 1:3906 HWY. 377
Practice Address - Street 2:SUITE 103
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049
Practice Address - Country:US
Practice Address - Phone:817-579-0100
Practice Address - Fax:817-279-0699
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPHTHALMIC PARTNERS, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137346605Medicaid
TX137346610Medicaid
TX137346611Medicaid
TX0001AHOtherBCBS
TXCD4664Medicare PIN
TX137346610Medicaid