1083761332 NPI number — IN VISION EYE CARE, L.L.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083761332 NPI number — IN VISION EYE CARE, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IN VISION EYE CARE, L.L.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:
BOA VISION CENTERS
Provider Other Organization Name Type Code:
3
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:
1083761332
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2924 S 31ST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEMPLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76502-1861
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-247-0636
Provider Business Mailing Address Fax Number:
254-247-0634

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
404 UNIVERSITY DR E
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
COLLEGE STATION
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77840-5905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-693-2891
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KLEIN
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT CEO
Authorized Official Telephone Number:
254-247-0636

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 139949513 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 21189 . This is a "HMO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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