Provider Demographics
NPI:1104881630
Name:SAW EYE ASSOCIATES PA
Entity type:Organization
Organization Name:SAW EYE ASSOCIATES PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WYLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-494-1451
Mailing Address - Street 1:1626 FOREST LANE
Mailing Address - Street 2:STE C
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042
Mailing Address - Country:US
Mailing Address - Phone:972-494-1451
Mailing Address - Fax:972-494-2105
Practice Address - Street 1:1626 FOREST LANE
Practice Address - Street 2:STE C
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042
Practice Address - Country:US
Practice Address - Phone:972-494-1451
Practice Address - Fax:972-494-2105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD5258207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180025949OtherRR MED
TX196845501Medicaid
TX196845502Medicaid
TX83035ZOtherBCBS
TX196845502Medicaid
TX196845501Medicaid
TX00X555Medicare PIN