Provider Demographics
NPI:1730364019
Name:T D VENTURES INC.
Entity type:Organization
Organization Name:T D VENTURES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:DEATHERAGE
Authorized Official - Suffix:
Authorized Official - Credentials:FNAO ABOC
Authorized Official - Phone:940-723-7241
Mailing Address - Street 1:2916 GARNETT AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-1002
Mailing Address - Country:US
Mailing Address - Phone:940-723-7241
Mailing Address - Fax:940-761-2025
Practice Address - Street 1:2916 GARNETT AVE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-1002
Practice Address - Country:US
Practice Address - Phone:940-723-7241
Practice Address - Fax:940-761-2025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156FX1800X
TX332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0860560001Medicare NSC
0860560001Medicare UPIN