Provider Demographics
NPI:1336319136
Name:DALLAS OPHTHALMOLOGY CENTER INC
Entity Type:Organization
Organization Name:DALLAS OPHTHALMOLOGY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:BENTLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:214-520-7444
Mailing Address - Street 1:4633 NORTH CENTRAL EXPRESSWAY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-4022
Mailing Address - Country:US
Mailing Address - Phone:214-520-7444
Mailing Address - Fax:214-443-7525
Practice Address - Street 1:4633 NORTH CENTRAL EXPRESSWAY
Practice Address - Street 2:SUITE 310
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-4022
Practice Address - Country:US
Practice Address - Phone:214-520-7600
Practice Address - Fax:214-528-6522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000211261QA1903X, 291U00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCL8249Medicare PIN