1508063504 NPI number — WHITNEY FAMILY EYECARE P.C.

Table of content: (NPI 1508063504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508063504 NPI number — WHITNEY FAMILY EYECARE P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHITNEY FAMILY EYECARE P.C.
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:
1508063504
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2067
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITNEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76692-5067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-694-3435
Provider Business Mailing Address Fax Number:
254-694-9968

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1221 N. BRAZOS STREET
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
WHITNEY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76692
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-694-3435
Provider Business Practice Location Address Fax Number:
254-694-9968
Provider Enumeration Date:
07/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EUBANK
Authorized Official First Name:
LON
Authorized Official Middle Name:
WHITFIELD
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
254-694-3435

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X , with the licence number:  5119TG , 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: 1427134493 . This is a "DR. NPI NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 019553901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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