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General NPI Number Information
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NPI Number | 1750468583
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Entity Type | Organization
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Legal Business Name | TEXAS EYE SURGERY CENTER, LLC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 05/27/2016
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Provider Practice Location Address
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Address Line | 1872 NORWOOD DR 100
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City | HURST
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State | TX
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Zip | 76054-3066
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Country | US
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Telephone | 817-554-0200
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Fax | 817-553-7994
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Provider Business Mailing Address
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Address Line | 1872 NORWOOD DR 100
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City | HURST
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State | TX
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Zip | 76054-3066
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Country | US
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Telephone | 817-540-6060
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Fax | 817-553-7994
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | BRIAN D RANELLE
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Credential | D.O.
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Telephone | 817-540-6060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 008515
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License Number State | TX
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