Provider Demographics
NPI:1952584690
Name:J A MAYANS MD PA
Entity Type:Organization
Organization Name:J A MAYANS MD PA
Other - Org Name:SOUTHWEST RETINA EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAYANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-333-1324
Mailing Address - Street 1:907 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79763
Mailing Address - Country:US
Mailing Address - Phone:432-333-1324
Mailing Address - Fax:432-337-7628
Practice Address - Street 1:907 W SECOND ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79763
Practice Address - Country:US
Practice Address - Phone:432-333-1324
Practice Address - Fax:432-337-7628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6029207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080824801Medicaid
TX00583KMedicare UPIN