Provider Demographics
NPI:1487609251
Name:PANHANDLE VISION CENTER - DUMAS PC
Entity type:Organization
Organization Name:PANHANDLE VISION CENTER - DUMAS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:R ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:806-935-7773
Mailing Address - Street 1:224 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:TX
Mailing Address - Zip Code:79029-4411
Mailing Address - Country:US
Mailing Address - Phone:806-935-7773
Mailing Address - Fax:806-935-7972
Practice Address - Street 1:224 E 7TH ST
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:TX
Practice Address - Zip Code:79029-4411
Practice Address - Country:US
Practice Address - Phone:806-935-7773
Practice Address - Fax:806-935-7972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E43YMedicare PIN
TXCE7454Medicare PIN
TX1192080001Medicare NSC