Provider Demographics
NPI:1679678239
Name:GLAUCOMA ASSOCIATES OF TEXAS PA
Entity Type:Organization
Organization Name:GLAUCOMA ASSOCIATES OF TEXAS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:FELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-360-0000
Mailing Address - Street 1:PO BOX 730475
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-0475
Mailing Address - Country:US
Mailing Address - Phone:972-791-1224
Mailing Address - Fax:972-819-0050
Practice Address - Street 1:7150 GREENVILLE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-7900
Practice Address - Country:US
Practice Address - Phone:214-360-0000
Practice Address - Fax:214-360-0083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00TS72OtherBCBS
TXCD4656Medicare PIN
TX00TS72OtherBCBS