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
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