Provider Demographics
NPI:1215299441
Name:TA EYE ASSOCIATES, PLLC
Entity type:Organization
Organization Name:TA EYE ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:TA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:843-450-0746
Mailing Address - Street 1:3811 S COOPER ST
Mailing Address - Street 2:SUITE #2004
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-4120
Mailing Address - Country:US
Mailing Address - Phone:817-472-5050
Mailing Address - Fax:
Practice Address - Street 1:3811 S COOPER ST
Practice Address - Street 2:SUITE #2004
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-4120
Practice Address - Country:US
Practice Address - Phone:817-472-5050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7771TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty