1336565639 NPI number — BEST EYE VISIONCARE, PLLC

Table of content: (NPI 1336565639)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336565639 NPI number — BEST EYE VISIONCARE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEST EYE VISIONCARE, PLLC
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:
1336565639
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6020 34TH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUBBOCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-318-8673
Provider Business Mailing Address Fax Number:
806-784-1466

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6020 34TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-318-8673
Provider Business Practice Location Address Fax Number:
806-784-1466
Provider Enumeration Date:
03/11/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
TEJAL
Authorized Official Middle Name:
M
Authorized Official Title or Position:
DOCTOR OF OPTOMETRY
Authorized Official Telephone Number:
806-318-8673

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  7795-TG , 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)