Provider Demographics
NPI:1205909272
Name:TEXARKANA EYE ASSOCIATES
Entity type:Organization
Organization Name:TEXARKANA EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
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 1:2703 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2328
Practice Address - Country:US
Practice Address - Phone:903-838-0783
Practice Address - Fax:903-831-6145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5241T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR8P157OtherAR BCBS
TX019333601Medicaid
TX00E39YOtherBCBS GROUP NUMBER
AR134244722Medicaid
TXDC3437Medicare PIN
TX00E39YMedicare PIN
TX019333601Medicaid