Provider Demographics
NPI:1659575926
Name:TEXAS VISION & LASER CENTER, PLLC
Entity Type:Organization
Organization Name:TEXAS VISION & LASER CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:BULLAJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-548-2015
Mailing Address - Street 1:2600 W UNIVERSITY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-3209
Mailing Address - Country:US
Mailing Address - Phone:972-548-2015
Mailing Address - Fax:972-548-2014
Practice Address - Street 1:2600 W UNIVERSITY DR STE 100
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-3209
Practice Address - Country:US
Practice Address - Phone:972-548-2015
Practice Address - Fax:972-548-2014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0053QCOtherBCBS
TX187626001Medicaid
DG6666Medicare PIN