Provider Demographics
NPI:1639419013
Name:REFRACTIVE SURGERY & DIAGNOSTIC CENTER PLLC
Entity Type:Organization
Organization Name:REFRACTIVE SURGERY & DIAGNOSTIC CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:D
Authorized Official - Last Name:PARKHURST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-585-2020
Mailing Address - Street 1:9725 DATAPOINT DR STE 106
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2385
Mailing Address - Country:US
Mailing Address - Phone:210-615-9358
Mailing Address - Fax:
Practice Address - Street 1:9725 DATAPOINT DR STE 106
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2385
Practice Address - Country:US
Practice Address - Phone:210-615-9358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-22
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX152W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty