MEDICARE: OAK CLIFF OPHTHALMOLOGY, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	L1988	TX

General Provider Information

NPI Number	:	1053702936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAK CLIFF OPHTHALMOLOGY, P.A.

Provider Business Mailing Address
First Line	:	1114 N BISHOP AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-4113
Country	:	US
Telephone Number	:	214-416-8100
Fax Number	:	214-419-8199

Provider Business Practice Location Address
First Line	:	1114 N BISHOP AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-4113
Country	:	US
Telephone Number	:	214-416-8100
Fax Number	:	214-419-8199

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEFFREY BRENT ROBERTSON
Credential	:	M.D.
Telephone Number	:	214-416-8100

Provider Enumeration Date	:	02/12/2015
Last Update Date	:	02/12/2015

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