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Organization

TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER LUBBOCK

Active
Other names
TTUHSC - Opthalmology
Organization subpart
No

Provider details

NPI number
Authorized official
BRENT MAGERS (CEO)
(806) 743-1830
Entity
Organization

Contact information

Practice address
3601 4TH ST, SUITE 2A100, LUBBOCK, TX 79430-0002
(806) 743-2020
(806) 743-1782
Mailing address
PO BOX 27476, SALT LAKE CITY, UT 84127-0476
(806) 743-4263
(806) 743-2787

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
261QM2500X
Medical Specialty Clinic/Center

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00QQ82
BC/BS
TX
05
084588501
TX
05
140327145
TX
01
CD9207
RAILROAD MEDICARE
TX
05
G1217
NM
Enumeration date
05/06/2006
Last updated
03/07/2022
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