Provider Demographics
NPI:1265991855
Name:TEXAS RETINA CENTER, PLLC
Entity type:Organization
Organization Name:TEXAS RETINA CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHEEN
Authorized Official - Middle Name:CYRUS
Authorized Official - Last Name:KAVOUSSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-725-8012
Mailing Address - Street 1:2929 WESLAYAN ST APT 1808
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-2025
Mailing Address - Country:US
Mailing Address - Phone:713-501-2621
Mailing Address - Fax:
Practice Address - Street 1:2929 WESLAYAN ST APT 1808
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-2025
Practice Address - Country:US
Practice Address - Phone:713-725-8012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery