NPIMap

Organization Active NPI

Texas Retina Associates

  • Ophthalmology Physician
  • Woodway, TX
National Provider Identifier
1629010376
Registry record updated May 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
TEXAS RETINA ASSOCIATES
Practice address
203 Archway Dr
Woodway, TX 76712-6105
Phone
(254) 753-7007
NPI assigned
Jun 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2023

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

Authorized official

Name
Jefferey T. Brockette
Title
Ceo
Phone
(214) 692-6941

Specialties & licenses 1

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

Addresses

Primary practice location

203 Archway Dr
Woodway, TX 76712-6105

Mailing address

PO Box 650037
Dallas, TX 75265-0037
Phone (214) 696-2008

Other identifiers 1

IdentifierTypeStateIssuer
094850705MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050221000018 TX Part B Supplier - Clinic/Group Practice 7012969843 Receives reassigned benefits from 18 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dallas, TX; Woodway, TX; Wichita Falls, TX; Sherman, TX; Rockwall, TX; Plano, TX; Mansfield, TX; Lubbock, TX…

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
Texas Retina Associates6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

801 W Randol Mill Rd
Ste 101
Arlington, TX 76012
Phone (817) 261-9625

9600 N Central Expy
Dallas, TX 75231

900 W Magnolia Ave
Ste 202
Fort Worth, TX 76104
Phone (817) 333-6795

1101 6th Ave
Ste 200
Fort Worth, TX 76104
Phone (817) 334-0882

1643 Lancaster Dr
Grapevine, TX 76051
Phone (248) 938-0141

2380 S Goliad St
Ste 120
Rockwall, TX 75032
Phone (972) 722-4739

715 E Taylor St
Sherman, TX 75090
Phone (903) 893-8443

7030 Sanger Rd
Ste 102
Waco, TX 76712
Phone (254) 399-9540

Practitioners & affiliated clinicians

Practitioners 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684195200000",
    "number": "1629010376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 650037",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752650037",
            "telephone_number": "214-696-2008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 ARCHWAY DR",
            "city": "WOODWAY",
            "state": "TX",
            "postal_code": "767126105",
            "telephone_number": "254-753-7007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEXAS RETINA ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-10",
        "last_updated": "2023-05-16",
        "certification_date": "2023-05-16",
        "status": "A",
        "authorized_official_last_name": "BROCKETTE",
        "authorized_official_first_name": "JEFFEREY",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "214-692-6941"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "094850705",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodway, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2023; 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.