Basic Information
Provider Information
NPI: 1386740413
EntityType: 2
ReplacementNPI:  
OrganizationName: OPHTHALMIC PARTNERS, PA
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 911791
Address2:  
City: DALLAS
State: TX
PostalCode: 753911791
CountryCode: US
TelephoneNumber: 9727911224
FaxNumber: 8775945434
Practice Location
Address1: 4708 ALLIANCE BLVD
Address2: SUITE 785
City: PLANO
State: TX
PostalCode: 750935340
CountryCode: US
TelephoneNumber: 9725999098
FaxNumber: 9722831448
Other Information
ProviderEnumerationDate: 09/16/2006
LastUpdateDate: 03/18/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: HENDRICKS
AuthorizedOfficialFirstName: G
AuthorizedOfficialMiddleName: DAVID
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 8173322020
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207W00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansOphthalmology 

No ID Information.


Home