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General NPI Number Information
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NPI Number | 1891678595
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Entity Type | Organization
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Legal Business Name | AZURE VISION SURGERY CENTER LLC
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Dates
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Enumeration Date | 07/29/2025
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 5203 HERITAGE AVE
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City | COLLEYVILLE
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State | TX
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Zip | 76034-5915
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Country | US
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Telephone | 817-891-1072
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Fax |
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Provider Business Mailing Address
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Address Line | 5203 HERITAGE AVE
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City | COLLEYVILLE
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State | TX
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Zip | 76034-5915
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Country | US
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Telephone | 817-891-1072
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | TILLIE ANDRADE
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Credential |
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Telephone | 702-449-9173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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