Organization
ADVANCED EYELID SURGERY CENTER & LASER CENTER
Active
Parent organization
ADVANCED EYELID SURGERY CENTER & LASER CENTER
Other names
Advanced Eyelid Surgery Center & Laser Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
ADVANCED EYELID SURGERY CENTER & LASER CENTER
Authorized official
MAYLI L DAVIS M.D. (DOCTOR)
(817) 329-4480
Entity
Organization
Contact information
Practice address
6407 COLLEYVILLE BLVD, SUITE B, COLLEYVILLE, TX 76034-6228
(817) 329-4480
(817) 488-5993
Mailing address
6407 COLLEYVILLE BLVD, SUITE B, COLLEYVILLE, TX 76034-6228
(817) 329-4480
(817) 488-5993
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
J5739
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0067EZ
BCBS
TX
05
—
127504201
—
TX
Enumeration date
01/07/2008
Last updated
10/06/2008
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