Provider Demographics
NPI:1396961959
Name:MIDLAND VISION HEALTH SPECIALTIES LLP
Entity type:Organization
Organization Name:MIDLAND VISION HEALTH SPECIALTIES LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:432-694-5259
Mailing Address - Street 1:4109 N MIDLAND DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-3500
Mailing Address - Country:US
Mailing Address - Phone:432-694-5259
Mailing Address - Fax:432-694-7694
Practice Address - Street 1:4109 N MIDLAND DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-3500
Practice Address - Country:US
Practice Address - Phone:432-694-5259
Practice Address - Fax:432-694-7694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019028001Medicaid
TX00520EMedicare PIN
TX1316360001Medicare NSC