1205952512 NPI number — SUGARLAND EYE & LASER CENTER PROFESSIONAL ASSOCIATION

Table of content: (NPI 1205952512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205952512 NPI number — SUGARLAND EYE & LASER CENTER PROFESSIONAL ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUGARLAND EYE & LASER CENTER PROFESSIONAL ASSOCIATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205952512
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
11/16/2020
NPI Reactivation Date:
12/21/2020

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
736 HIGHWAY 6
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77478-5103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-240-0478
Provider Business Mailing Address Fax Number:
281-240-0479

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
736 HIGHWAY 6
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SUGAR LAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77478-5103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-240-0478
Provider Business Practice Location Address Fax Number:
281-240-0479
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KHAN
Authorized Official First Name:
RUBI
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING
Authorized Official Telephone Number:
281-240-0478

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  L3360 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: L3360 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 171203601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0071MD . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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