Provider Demographics
NPI:1962588004
Name:CONSOLIDATED OPTICALS OF TEXAS, INC.
Entity type:Organization
Organization Name:CONSOLIDATED OPTICALS OF TEXAS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-778-9100
Mailing Address - Street 1:98 COVE TERRACE
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522
Mailing Address - Country:US
Mailing Address - Phone:254-542-2020
Mailing Address - Fax:254-547-8100
Practice Address - Street 1:98 COVE TERRACE
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522
Practice Address - Country:US
Practice Address - Phone:254-542-2020
Practice Address - Fax:254-547-8100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0661407-01Medicaid