Provider Demographics
NPI:1699759399
Name:DALLAS OPHTHALMOLOGY CENTER INC
Entity type:Organization
Organization Name:DALLAS OPHTHALMOLOGY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:POINTS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-520-7600
Mailing Address - Street 1:4633 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-4022
Mailing Address - Country:US
Mailing Address - Phone:215-520-7600
Mailing Address - Fax:214-528-6522
Practice Address - Street 1:4633 N CENTRAL EXPY
Practice Address - Street 2:SUITE 310
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-4022
Practice Address - Country:US
Practice Address - Phone:215-520-7600
Practice Address - Fax:214-528-6522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000211261QA1903X
TXCLIA4500707003291U00000X
TXCL8249291U00000X
TX20377CLASSC333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No291U00000XLaboratoriesClinical Medical Laboratory
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX451078Medicare PIN