Basic Information
| Provider Information | |||||||||
| NPI: | 1629139324 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH TEXAS OPHTHALMIC PLASTIC SURGERY, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 8TH AVE | ||||||||
| Address2: | STE 330 | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761042601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175661500 | ||||||||
| FaxNumber: | 6824320763 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 8TH AVE | ||||||||
| Address2: | STE 330 | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761042601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175661500 | ||||||||
| FaxNumber: | 6824320763 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 10/05/2015 | ||||||||
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| AuthorizedOfficialLastName: | FLORES | ||||||||
| AuthorizedOfficialFirstName: | LACY | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8175661500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.