=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225292741
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL DELLIS, O.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2008
-----------------------------------------------------
Last Update Date | 06/21/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 E FRANKLIN ST
-----------------------------------------------------
City | HILLSBORO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76645-2676
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-582-2351
-----------------------------------------------------
Fax | 254-582-7017
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 779
-----------------------------------------------------
City | HILLSBORO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76645-0779
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-582-2351
-----------------------------------------------------
Fax | 254-582-7017
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MICHAEL DEAN DELLIS
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 254-582-2351
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2348T
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------