1134143688 NPI number — SOUTH TEXAS EYE CONSULTANTS

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 1134143688 NPI number — SOUTH TEXAS EYE CONSULTANTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH TEXAS EYE CONSULTANTS
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:
6
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:
1134143688
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2222 MORGAN AVE
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
CORPUS CHRISTI
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78405-1948
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-992-9400
Provider Business Mailing Address Fax Number:
361-992-8295

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5402 S STAPLES ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78411-4670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-992-9400
Provider Business Practice Location Address Fax Number:
361-992-8295
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DIETZE
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
RUSSELL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
361-992-9400

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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