Provider Demographics
NPI:1861575086
Name:OPA 1, LTD
Entity type:Organization
Organization Name:OPA 1, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOLYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-660-8801
Mailing Address - Street 1:7301 FANNIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4807
Mailing Address - Country:US
Mailing Address - Phone:713-797-0011
Mailing Address - Fax:713-797-0010
Practice Address - Street 1:627 WINNIE ST
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-5231
Practice Address - Country:US
Practice Address - Phone:409-765-5300
Practice Address - Fax:409-765-6224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101102335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101102OtherSTATE LICENSE
TXC08439048Medicare PIN
TX101102OtherSTATE LICENSE