NPIMap

Organization Active NPI

Ophthalmic Partners, PA

  • Ophthalmology Physician
  • Desoto, TX
National Provider Identifier
1245336718
Registry record updated Mar 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
OPHTHALMIC PARTNERS, PA
Practice address
2625 Bolton Boone Dr
Desoto, TX 75115-2011
Phone
(972) 283-1516
Fax
(972) 283-1448
NPI assigned
Sep 15, 2006
Last updated
Mar 18, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2008

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

Authorized official

Name
David Hendricks, MD
Title
President
Phone
(817) 332-2020

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X NU Primary
Surgery Physician 208600000X NU

Addresses

Primary practice location

2625 Bolton Boone Dr
Desoto, TX 75115-2011

Mailing address

PO Box 911791
Dallas, TX 75391-1791
Phone (972) 791-1224

Other identifiers 1

IdentifierTypeStateIssuer
1373466 10MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031117000188 TX Part B Supplier - Clinic/Group Practice 4587578364 Receives reassigned benefits from 17 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fort Worth, TX; Granbury, TX; Hurst, TX; Weatherford, TX

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

2625 Bolton Boone Dr
Desoto, TX 75115
Phone (972) 283-1516

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205798400000",
    "number": "1245336718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 911791",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753911791",
            "telephone_number": "972-791-1224",
            "fax_number": "877-594-5434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2625 BOLTON BOONE DR",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751152011",
            "telephone_number": "972-283-1516",
            "fax_number": "972-283-1448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPHTHALMIC PARTNERS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-15",
        "last_updated": "2008-03-18",
        "status": "A",
        "authorized_official_last_name": "HENDRICKS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "817-332-2020",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1373466 10",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Desoto, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 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.