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General NPI Number Information
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NPI Number | 1609039874
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON
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Dates
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Enumeration Date | 07/08/2008
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Last Update Date | 07/08/2008
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Provider Practice Location Address
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Address Line | 700 UNIVERSITY BLVD UTMB DEPT OF OPHTHALMOLOGY
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City | GALVESTON
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State | TX
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Zip | 77550-5552
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Country | US
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Telephone | 409-747-5401
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Fax |
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Provider Business Mailing Address
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Address Line | 3427 ASHTON PARK DR
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City | HOUSTON
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State | TX
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Zip | 77082-5309
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Country | US
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Telephone | 713-291-4137
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN OF OPHTHALMOLOGY
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Name | BERNARD GODLEY
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Credential | M.D.
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Telephone | 409-747-5413
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | N0152
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License Number State | TX
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