Provider Demographics
NPI:1629081724
Name:TEXARKANA VISION GROUP PLLC
Entity Type:Organization
Organization Name:TEXARKANA VISION GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:CAROZZA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:903-280-1111
Mailing Address - Street 1:PO BOX 6986
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75505-6986
Mailing Address - Country:US
Mailing Address - Phone:903-280-1111
Mailing Address - Fax:870-772-1096
Practice Address - Street 1:4224 TEXAS BLVD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-3013
Practice Address - Country:US
Practice Address - Phone:903-280-1111
Practice Address - Fax:870-772-1096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherEIN