Basic Information
| Provider Information | |||||||||
| NPI: | 1790426286 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TELEOPTOMETRIC SERVICE TX, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1979 MARCUS AVE STE 206 | ||||||||
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| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110421002 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2703 RICHMOND RD | ||||||||
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| City: | TEXARKANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 755032328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9038380783 | ||||||||
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| ProviderEnumerationDate: | 04/06/2022 | ||||||||
| LastUpdateDate: | 04/06/2022 | ||||||||
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| AuthorizedOfficialLastName: | BASILE | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER OF OPEN DOCTOR PANEL | ||||||||
| AuthorizedOfficialTelephone: | 5162438708 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.