Provider Demographics
NPI:1598044182
Name:NATSIRT PC
Entity Type:Organization
Organization Name:NATSIRT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CROSBY
Authorized Official - Middle Name:W
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-355-9090
Mailing Address - Street 1:6640 CYPRESSWOOD DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-7737
Mailing Address - Country:US
Mailing Address - Phone:281-355-9090
Mailing Address - Fax:281-602-8419
Practice Address - Street 1:6640 CYPRESSWOOD DR
Practice Address - Street 2:SUITE 105
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-7737
Practice Address - Country:US
Practice Address - Phone:281-355-9090
Practice Address - Fax:281-602-8419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5527TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty