Provider Demographics
NPI:1962450668
Name:RICHARD B CULBERT MD PA
Entity Type:Organization
Organization Name:RICHARD B CULBERT MD PA
Other - Org Name:PREMIER RETINA SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:BBA
Authorized Official - Phone:432-617-0181
Mailing Address - Street 1:PO BOX 61880
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79711-1880
Mailing Address - Country:US
Mailing Address - Phone:432-617-0181
Mailing Address - Fax:432-563-0656
Practice Address - Street 1:10100 LOOP 40
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79706-2205
Practice Address - Country:US
Practice Address - Phone:432-332-2682
Practice Address - Fax:432-582-2557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166712301Medicaid
TX166712301Medicaid