Provider Demographics
NPI:1538277298
Name:WORLEY, MAX J (OD)
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:J
Last Name:WORLEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 615
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75151-0615
Mailing Address - Country:US
Mailing Address - Phone:903-872-5681
Mailing Address - Fax:903-872-0603
Practice Address - Street 1:202 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-5202
Practice Address - Country:US
Practice Address - Phone:903-872-5681
Practice Address - Fax:903-872-0603
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX1801152W00000X
TX1801TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093032301Medicaid
TXT16743Medicare UPIN
TX093032301Medicaid
TX4575510001Medicare NSC
TX00E05BMedicare PIN