Provider Demographics
NPI:1790111037
Name:AMARILLO OPHTHALMIC ASSOCIATES PA
Entity Type:Organization
Organization Name:AMARILLO OPHTHALMIC ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-352-3157
Mailing Address - Street 1:3501 S SONCY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-6407
Mailing Address - Country:US
Mailing Address - Phone:806-352-3157
Mailing Address - Fax:806-358-0041
Practice Address - Street 1:3501 S SONCY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6407
Practice Address - Country:US
Practice Address - Phone:806-352-3157
Practice Address - Fax:806-358-0041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4641-TG152W00000X
TXJ8554207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty