Provider Demographics
NPI:1386728756
Name:GLAUCOMA SPECIALISTS OF TEXAS SHP PA
Entity type:Organization
Organization Name:GLAUCOMA SPECIALISTS OF TEXAS SHP PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMYTHE
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:817-885-7878
Mailing Address - Street 1:1602 LANCASTER DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3574
Mailing Address - Country:US
Mailing Address - Phone:817-885-7878
Mailing Address - Fax:817-885-7444
Practice Address - Street 1:1602 LANCASTER DR
Practice Address - Street 2:SUITE 102
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3574
Practice Address - Country:US
Practice Address - Phone:817-885-7878
Practice Address - Fax:817-885-7444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX006MNOtherBLUE CROSS BLUE SHIELD
TX1609869692OtherNPI - PROVIDER
TXDD4140OtherRAILROAD MEDICARE
TXDD4140OtherRAILROAD MEDICARE
TX006MNOtherBLUE CROSS BLUE SHIELD