NPIMap

Organization Active NPI

Texas Retina Associates

  • Ophthalmology Physician
  • Plano, TX
National Provider Identifier
1821007675
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
1708 Coit Rd
Suite 215
Plano, TX 75075-5024
Phone
(972) 596-9222
NPI assigned
Aug 7, 2006
Last updated
May 16, 2023By the provider in NPPES
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 Brockette
Title
Ceo
Phone
(214) 692-6941

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X Primary

Addresses

Primary practice location

1708 Coit Rd
Suite 215
Plano, TX 75075-5024

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
094850704MedicaidTX

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.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2117288Texas Retina Associates1708 Coit Road, Suite 215, Plano, TX 75075Certificate of waiverAug 11, 2026

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

1001 N Waldrop Dr
Ste 512
Arlington, TX 76012
Phone (817) 261-9625

405 E Clinton Ave
Ste A
Athens, TX 75751
Phone (800) 695-6941

10740 N Central Expy
Ste 170
Dallas, TX 75231
Phone (214) 328-3610

1040 Texan Trl
Ste 100
Grapevine, TX 76051
Phone (817) 310-0107

1643 Lancaster Dr
Ste 306
Grapevine, TX 76051
Phone (817) 310-0107

505 N Gun Barrel Ln
Gun Barrel City, TX 75156
Phone (903) 887-7623

3802 22nd St
Ste B
Lubbock, TX 79410
Phone (806) 792-0066

2925 E Broad St
Mansfield, TX 76063
Phone (817) 477-0223

4550 Lamar Ave
Ste 400
Paris, TX 75462
Phone (903) 739-8321

575 Deshong Dr
#B
Paris, TX 75460
Phone (903) 739-8321

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

6767 Southwest Pkwy
Ste 160
Wichita Falls, TX 76310
Phone (940) 691-3232

203 Archway Dr
Woodway, TX 76712
Phone (254) 753-7007

Practitioners & affiliated clinicians

Practitioners 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1154908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684195200000",
    "number": "1821007675",
    "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": "1708 COIT RD",
            "address_2": "SUITE 215",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750755024",
            "telephone_number": "972-596-9222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEXAS RETINA ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-07",
        "last_updated": "2023-05-16",
        "certification_date": "2023-05-16",
        "status": "A",
        "authorized_official_last_name": "BROCKETTE",
        "authorized_official_first_name": "JEFFEREY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "214-692-6941"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "094850704",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plano, 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.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.