Provider Demographics
NPI:1265588461
Name:EYE CONSULTANTS OF TEXAS PA
Entity type:Organization
Organization Name:EYE CONSULTANTS OF TEXAS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIPS
Authorized Official - Middle Name:KIRK
Authorized Official - Last Name:LABOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-410-2030
Mailing Address - Street 1:2201 WESTGATE PLAZA
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3593
Mailing Address - Country:US
Mailing Address - Phone:817-410-2030
Mailing Address - Fax:817-251-6261
Practice Address - Street 1:2201 WESTGATE PLZ
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8037
Practice Address - Country:US
Practice Address - Phone:817-410-2030
Practice Address - Fax:817-251-6261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-28
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7044207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157405501Medicaid
TX157405501Medicaid
TXCK8033Medicare PIN
TXF35264Medicare UPIN
TX00535UMedicare ID - Type Unspecified