Provider Demographics
NPI:1184914806
Name:VRCEK, IVAN (MD)
Entity type:Individual
Prefix:
First Name:IVAN
Middle Name:
Last Name:VRCEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9301 N CENTRAL EXPY STE 595
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-0812
Mailing Address - Country:US
Mailing Address - Phone:214-522-7733
Mailing Address - Fax:214-521-5433
Practice Address - Street 1:9301 N CENTRAL EXPY STE 595
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-0812
Practice Address - Country:US
Practice Address - Phone:214-522-7733
Practice Address - Fax:214-521-5433
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXQ2218207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program