Provider Demographics
NPI:1023336849
Name:TEXARKANA EYE ASSOCIATES
Entity type:Organization
Organization Name:TEXARKANA EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELVIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:FENTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:903-838-0783
Mailing Address - Street 1:2703 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-2328
Mailing Address - Country:US
Mailing Address - Phone:903-838-0783
Mailing Address - Fax:903-831-6145
Practice Address - Street 1:1425 E LINCOLN RD
Practice Address - Street 2:SUITE A-1
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-7345
Practice Address - Country:US
Practice Address - Phone:580-286-6000
Practice Address - Fax:903-831-6145
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXARKANA EYE ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-05
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2625152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKA102183Medicare PIN