Organization
BRIAN M. CELICO, OD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN M. CELICO O.D. (PRESIDENT/OWNER)
(214) 265-1111
Entity
Organization
Contact information
Practice address
7150 GREENVILLE AVE, SUITE 305, DALLAS, TX 75231-5185
(214) 265-1111
Mailing address
7150 GREENVILLE AVE, SUITE 305, DALLAS, TX 75231-5185
(214) 265-1111
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3455 TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00E69U
BLUE CROSS OF TEXAS
TX
05
—
0194615-01
—
TX
Enumeration date
04/10/2008
Last updated
03/20/2012
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