Provider Demographics
NPI:1063212157
Name:WEST TEXAS EYE PA
Entity type:Organization
Organization Name:WEST TEXAS EYE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PES
Authorized Official - Prefix:
Authorized Official - First Name:RONISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-598-7495
Mailing Address - Street 1:63 S ROCKFORD DR STE 220
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85288-6226
Mailing Address - Country:US
Mailing Address - Phone:602-955-1000
Mailing Address - Fax:
Practice Address - Street 1:805 W WADLEY AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-6557
Practice Address - Country:US
Practice Address - Phone:806-792-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST TEXAS EYE PA DBA WEST TEXAS EYE ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies