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General NPI Number Information
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NPI Number | 1255797379
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Entity Type | Organization
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Legal Business Name | MIDLAND EYE CARE, PA
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Dates
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Enumeration Date | 01/05/2016
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Last Update Date | 01/05/2016
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Provider Practice Location Address
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Address Line | 4400 N MIDLAND DR STE 404
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City | MIDLAND
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State | TX
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Zip | 79707-3388
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Country | US
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Telephone | 432-695-6259
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Fax |
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Provider Business Mailing Address
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Address Line | 4400 N MIDLAND DR STE 404
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City | MIDLAND
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State | TX
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Zip | 79707-3388
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | SRIYUTA THOTA
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Credential | OD
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Telephone | 281-989-3155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 6263
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License Number State | TX
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