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NPI Code Detail

MEDICARE: TEXAS RETINA ASSOCIATES

MEDICARE: TEXAS RETINA ASSOCIATES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207W00000XOphthalmology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417999855
Entity Type Code : Organization
Provider Name (Legal Business Name) : TEXAS RETINA ASSOCIATES
Provider Business Mailing Address
First Line : PO BOX 650037
Second Line :
City : DALLAS
State : TX
Zip : 75265-0037
Country : US
Telephone Number : 214-696-2008
Fax Number :
Provider Business Practice Location Address
First Line : 9600 N CENTRAL EXPY STE 100
Second Line :
City : DALLAS
State : TX
Zip : 75231-5078
Country : US
Telephone Number : 214-692-6941
Fax Number :
Authorized Official
Title or Position : CEO
Name : JEFFEREY T. BROCKETTE
Credential :
Telephone Number : 214-692-6941
Provider Enumeration Date : 06/11/2006
Last Update Date : 05/16/2023

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Directions to “TEXAS RETINA ASSOCIATES ” Practice Location

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