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General NPI Number Information
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NPI Number | 1205016466
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Entity Type | Organization
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Legal Business Name | EYE SPECIALISTS AND LASER CENTER OF TEXAS
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Dates
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Enumeration Date | 11/05/2007
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Last Update Date | 03/03/2010
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Provider Practice Location Address
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Address Line | 1650 W ROSEDALE ST SUITE 202
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City | FORT WORTH
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State | TX
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Zip | 76104-7400
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Country | US
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Telephone | 817-336-4401
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Fax | 817-335-2012
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Provider Business Mailing Address
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Address Line | 370 W HWY 121 SUITE 105
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City | COPPELL
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State | TX
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Zip | 75019
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Country | US
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Telephone | 972-899-8070
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Fax | 972-899-8072
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Authorized Official
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Title or Position | PHYSICIAN
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Name | SUBIR S BHATIA
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Credential |
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Telephone | 817-336-4401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | M2903
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License Number State | TX
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