Provider Demographics
NPI:1902802036
Name:CATARACT & SURGICAL CENTER OF LUBBOCK LLC
Entity Type:Organization
Organization Name:CATARACT & SURGICAL CENTER OF LUBBOCK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:T
Authorized Official - Last Name:KHATER, M.D.,PH.D.
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PHD
Authorized Official - Phone:806-792-5900
Mailing Address - Street 1:5109 80TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-3017
Mailing Address - Country:US
Mailing Address - Phone:806-792-5900
Mailing Address - Fax:806-792-6092
Practice Address - Street 1:5109 80TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-3017
Practice Address - Country:US
Practice Address - Phone:806-792-5900
Practice Address - Fax:806-792-6092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007864261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH1579OtherBLUE SHIELD
TXASC145Medicare PIN