Provider Demographics
NPI:1700126570
Name:DR BUIE & ASSOCIATES PC
Entity Type:Organization
Organization Name:DR BUIE & ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BERTRAM
Authorized Official - Middle Name:Z
Authorized Official - Last Name:BUIE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-570-0545
Mailing Address - Street 1:PO BOX 1053
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-1053
Mailing Address - Country:US
Mailing Address - Phone:817-741-1805
Mailing Address - Fax:
Practice Address - Street 1:1880 MILITARY PARKWAY
Practice Address - Street 2:
Practice Address - City:FT. WORTH
Practice Address - State:TX
Practice Address - Zip Code:76127
Practice Address - Country:US
Practice Address - Phone:817-570-0545
Practice Address - Fax:817-570-0543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6525-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGMedicare PIN