Organization
MHR EYE ASSOCIATION, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEANNA TIDWELL (ADMINISTRATOR)
(817) 310-6080
Entity
Organization
Contact information
Practice address
1310 N WHITE CHAPEL BLVD STE 208, SOUTHLAKE, TX 76092-4308
(817) 310-6080
(817) 310-6014
Mailing address
1310 N WHITE CHAPEL BLVD STE 208, SOUTHLAKE, TX 76092-4308
(817) 310-6080
(817) 310-6014
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007NC
BLUECROSSBLUESHIELD
TX
01
—
5158536
AETNA
TX
Enumeration date
12/18/2006
Last updated
12/22/2023
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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