MEDICARE: DALLAS OPHTHALMOLOGY CENTER INC

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	261QA1903X	Ambulatory Surgical Clinic/Center	000211	TX
2	333600000X	Pharmacy	000211	TX
3	291U00000X	Clinical Medical Laboratory	000211	TX

General Provider Information

NPI Number	:	1336319136
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DALLAS OPHTHALMOLOGY CENTER INC

Provider Business Mailing Address
First Line	:	4633 NORTH CENTRAL EXPRESSWAY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75205-4022
Country	:	US
Telephone Number	:	214-520-7444
Fax Number	:	214-443-7525

Provider Business Practice Location Address
First Line	:	4633 NORTH CENTRAL EXPRESSWAY
Second Line	:	SUITE 310
City	:	DALLAS
State	:	TX
Zip	:	75205-4022
Country	:	US
Telephone Number	:	214-520-7600
Fax Number	:	214-528-6522

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES A BENTLEY JR.
Credential	:	MD
Telephone Number	:	214-520-7444

Provider Enumeration Date	:	03/07/2008
Last Update Date	:	03/07/2008

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