Provider Demographics
NPI:1184733586
Name:WEST TEXAS EYE PA
Entity type:Organization
Organization Name:WEST TEXAS EYE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROOKFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-598-7065
Mailing Address - Street 1:63 S ROCKFORD DR STE 220
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85288-6226
Mailing Address - Country:US
Mailing Address - Phone:602-598-7488
Mailing Address - Fax:602-231-6215
Practice Address - Street 1:12210 QUAKER AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-7789
Practice Address - Country:US
Practice Address - Phone:806-412-5165
Practice Address - Fax:806-792-6092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X, 332H00000X, 207W00000X
TXK3276261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic SurgeryGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174103503Medicaid
DG8220OtherRAILROAD MEDICARE
Y30806Medicare UPIN
TX174103503Medicaid
DG8220OtherRAILROAD MEDICARE
6333090001Medicare NSC