Basic Information
| Provider Information | |||||||||
| NPI: | 1104922517 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CORNEA ASSOCIATES OF TEXAS PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 730486 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753730486 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727911224 | ||||||||
| FaxNumber: | 9728190050 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | CORSICANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751102471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9038724611 | ||||||||
| FaxNumber: | 9038740701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2006 | ||||||||
| LastUpdateDate: | 12/12/2007 | ||||||||
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| AuthorizedOfficialLastName: | GELENDER | ||||||||
| AuthorizedOfficialFirstName: | HENRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2146920146 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 184585103 | 05 | TX | MEDICAID | 0071PC | 01 | TX | BCBS | OTHER |