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Organization

PEDIATRIC EYE SPECIALISTS LLP

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LORETTA TAYLOR (CREDENTIALING COORDINATOR)
(817) 529-9949
Entity
Organization

Contact information

Practice address
321 S HENDERSON ST, FORT WORTH, TX 76104-1016
(817) 529-9949
(817) 529-9943
Mailing address
321 S HENDERSON ST, FORT WORTH, TX 76104-1016
(817) 529-9949
(817) 529-9943

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
L2508 L8376 L047
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
018440004
TX
05
145291402
TX
05
152778001
TX
05
166926901
TX
05
323588905
TX
Enumeration date
03/21/2007
Last updated
06/11/2019
About Stedi
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