Provider Demographics
NPI:1639884695
Name:KAD OPHTHALMOLOGY PLLC
Entity Type:Organization
Organization Name:KAD OPHTHALMOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KOURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DWYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-600-5799
Mailing Address - Street 1:2301 S FM 51 STE 300
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-3864
Mailing Address - Country:US
Mailing Address - Phone:940-600-5799
Mailing Address - Fax:940-600-5796
Practice Address - Street 1:2301 S FM 51 STE 300
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3864
Practice Address - Country:US
Practice Address - Phone:940-600-5799
Practice Address - Fax:940-600-5796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty