Provider Demographics
NPI:1790088243
Name:TAYLOR R. BROOKS, O.D, P.C
Entity Type:Organization
Organization Name:TAYLOR R. BROOKS, O.D, P.C
Other - Org Name:BROOKS EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-552-0252
Mailing Address - Street 1:1650 W NORTHWEST HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-8109
Mailing Address - Country:US
Mailing Address - Phone:817-552-0252
Mailing Address - Fax:817-552-0255
Practice Address - Street 1:1650 W NORTHWEST HWY
Practice Address - Street 2:SUITE 202
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8109
Practice Address - Country:US
Practice Address - Phone:817-552-0252
Practice Address - Fax:817-552-0255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5555T305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU77611Medicare UPIN
TXTXB118618Medicare PIN