Organization Active NPI

Fagadau & Hawk, M.D LLP

  • Ophthalmology Physician
  • Dallas, TX
National Provider Identifier
1003940388
Registry record updated Jul 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
FAGADAU & HAWK, M.D LLP
Practice address
6131 Luther LN Ste 216
Dallas, TX 75225
Phone
(214) 987-2020
Fax
(214) 739-3725
NPI assigned
Mar 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Kathleen A Davis
Title
Office Administrator
Phone
(214) 987-2020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X TX Primary

Addresses

Primary practice location

6131 Luther LN Ste 216
Dallas, TX 75225

Mailing address

6131 Luther LN Ste 216
Dallas, TX 75225
Phone (214) 987-2020

Other identifiers 2

IdentifierTypeStateIssuer
1145005-03MedicaidTX
1104887-02MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100617000087 TX Part B Supplier - Clinic/Group Practice 6507996519 Receives reassigned benefits from 7 practitioners
Practice locations: Dallas, TX

National Provider Directory

National Provider Directory

Locations

5744 Lyndon B Johnson Fwy
Dallas, TX 75240
Phone 8175168811101

6131 Luther Ln
Ste 216
Dallas, TX 75225
Phone (214) 987-2020

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215993600000",
    "number": "1003940388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6131 LUTHER LN STE 216",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "75225",
            "telephone_number": "214-987-2020",
            "fax_number": "214-739-3725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6131 LUTHER LN STE 216",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "75225",
            "telephone_number": "214-987-2020",
            "fax_number": "214-739-3725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAGADAU & HAWK, M.D LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-16",
        "last_updated": "2008-07-14",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICE ADMINISTRATOR",
        "authorized_official_telephone_number": "214-987-2020",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1145005-03",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1104887-02",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.