Provider Demographics
NPI:1932151495
Name:HARGRAVE EYE CENTER, PA
Entity Type:Organization
Organization Name:HARGRAVE EYE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARGRAVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-572-6262
Mailing Address - Street 1:1411 N BECKLEY AVE
Mailing Address - Street 2:STE#460
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208
Mailing Address - Country:US
Mailing Address - Phone:972-572-6262
Mailing Address - Fax:972-572-0423
Practice Address - Street 1:1411 N BECKLEY AVE
Practice Address - Street 2:STE#460
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208
Practice Address - Country:US
Practice Address - Phone:972-572-6262
Practice Address - Fax:972-572-0423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157136602Medicaid
TX00766UMedicare PIN
TX5277090001Medicare NSC