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NPI Code Detail

MEDICARE: FORT WORTH EYE ASSOCIATES

MEDICARE: FORT WORTH EYE ASSOCIATES
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
1332H00000XEyewear SupplierTX

General Provider Information

NPI Number : 1063650430
Entity Type Code : Organization
Provider Name (Legal Business Name) : FORT WORTH EYE ASSOCIATES
Provider Business Mailing Address
First Line : 5000 COLLINWOOD
Second Line :
City : FORT WORTH
State : TEXAS
Zip : 76107
Country : UM
Telephone Number : 817-732-9307
Fax Number : 817-732-5499
Provider Business Practice Location Address
First Line : 5000 COLLINWOOD AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-3606
Country : US
Telephone Number : 817-732-9307
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. H. WILLLIAM RANELLE X
Credential : D.O.
Telephone Number : 817-732-9307
Provider Enumeration Date : 01/23/2009
Last Update Date : 03/04/2009

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Directions to “FORT WORTH EYE ASSOCIATES ” Practice Location

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