Provider Demographics
NPI:1104464379
Name:UVEITIS CENTER OF TEXAS
Entity type:Organization
Organization Name:UVEITIS CENTER OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-304-9116
Mailing Address - Street 1:6500 SIERRA DR # 170
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2480
Mailing Address - Country:US
Mailing Address - Phone:972-331-1590
Mailing Address - Fax:
Practice Address - Street 1:6500 SIERRA DR # 170
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2480
Practice Address - Country:US
Practice Address - Phone:972-331-1590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0108XAllopathic & Osteopathic PhysiciansOphthalmologyUveitis and Ocular Inflammatory DiseaseGroup - Single Specialty