Provider Demographics
NPI:1750468583
Name:TEXAS EYE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:TEXAS EYE SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:RANELLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-540-6060
Mailing Address - Street 1:1872 NORWOOD DR
Mailing Address - Street 2:100
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3066
Mailing Address - Country:US
Mailing Address - Phone:817-540-6060
Mailing Address - Fax:817-553-7994
Practice Address - Street 1:1872 NORWOOD DR
Practice Address - Street 2:100
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3066
Practice Address - Country:US
Practice Address - Phone:817-554-0200
Practice Address - Fax:817-553-7994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008515261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXASC333Medicare PIN