Healthcare Provider Details

I. General information

NPI: 1699759399
Provider Name (Legal Business Name): DALLAS OPHTHALMOLOGY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4633 N CENTRAL EXPY SUITE 310
DALLAS TX
75205-4022
US

IV. Provider business mailing address

4633 N CENTRAL EXPY SUITE 310
DALLAS TX
75205-4022
US

V. Phone/Fax

Practice location:
  • Phone: 215-520-7600
  • Fax: 214-528-6522
Mailing address:
  • Phone: 215-520-7600
  • Fax: 214-528-6522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number000211
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberCLIA4500707003
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberCL8249
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number20377CLASSC
License Number StateTX

VIII. Authorized Official

Name: SUSAN POINTS
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 214-520-7600