Provider Demographics
NPI:1437477510
Name:LAS COLINAS OPHTHALMOLOGY ASSOCIATION
Entity type:Organization
Organization Name:LAS COLINAS OPHTHALMOLOGY ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:F
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-556-1915
Mailing Address - Street 1:440 W IH 635 FWY
Mailing Address - Street 2:SUITE 355
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3768
Mailing Address - Country:US
Mailing Address - Phone:972-556-1915
Mailing Address - Fax:972-556-1877
Practice Address - Street 1:440 W IH 635 FWY
Practice Address - Street 2:SUITE 355
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3768
Practice Address - Country:US
Practice Address - Phone:972-556-1915
Practice Address - Fax:972-556-1877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6623174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00EZ89OtherMEDICARE
TX033085401Medicaid
TX00EZ89OtherMEDICARE