1245406115 NPI number — EYEMASTERS OF TEXAS LTD

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 1245406115 NPI number — EYEMASTERS OF TEXAS LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYEMASTERS OF TEXAS LTD
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:
1245406115
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 848449
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75284-8449
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-524-6803
Provider Business Mailing Address Fax Number:
210-524-6587

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12700 HILL COUNTRY GALLERIA BLVD
Provider Second Line Business Practice Location Address:
SUITE S110
Provider Business Practice Location Address City Name:
BEE CAVE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-263-2349
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/01/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NEWCOM
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
ALLAN
Authorized Official Title or Position:
VP MANAGED VISION CARE
Authorized Official Telephone Number:
210-524-6700

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)