Provider Demographics
NPI:1104076082
Name:DENNIS K NEELY OD
Entity type:Organization
Organization Name:DENNIS K NEELY OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGUERITE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEELY
Authorized Official - Suffix:
Authorized Official - Credentials:CPOT
Authorized Official - Phone:432-523-2660
Mailing Address - Street 1:301 NW AVE B
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:TX
Mailing Address - Zip Code:79714-5708
Mailing Address - Country:US
Mailing Address - Phone:432-523-2660
Mailing Address - Fax:432-523-6312
Practice Address - Street 1:301 NW AVE B
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:TX
Practice Address - Zip Code:79714-5708
Practice Address - Country:US
Practice Address - Phone:432-523-2660
Practice Address - Fax:432-523-6312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3371TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E16YOtherBCBS
TX019240301Medicaid
TX019240301Medicaid