Provider Demographics
NPI:1669653051
Name:DALLAS VISION CENTER INC
Entity Type:Organization
Organization Name:DALLAS VISION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:VODVARKA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-241-8084
Mailing Address - Street 1:414 PARK FOREST CTR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-8065
Mailing Address - Country:US
Mailing Address - Phone:972-241-8084
Mailing Address - Fax:972-241-8086
Practice Address - Street 1:11888 MARSH LN
Practice Address - Street 2:SUITE 414
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-8083
Practice Address - Country:US
Practice Address - Phone:972-241-8084
Practice Address - Fax:972-241-8086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTG2057332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX410033055OtherRAILROAD PIN
TX1316922982OtherINDIVIDUAL NPI
TX8A8260OtherMEDICARE INDIVIDUAL NUMBER
TX00386VMedicare PIN
TX1316922982OtherINDIVIDUAL NPI
TX8A8260OtherMEDICARE INDIVIDUAL NUMBER