1447259155 NPI number — CORPUS CHRISTI EYE ASSOCIATES PLLC

Table of content: (NPI 1447259155)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447259155 NPI number — CORPUS CHRISTI EYE ASSOCIATES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORPUS CHRISTI EYE ASSOCIATES 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:
EYE ASSOCIATES OF CORPUS CHRISTI
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:
1447259155
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3301 S ALAMEDA ST
Provider Second Line Business Mailing Address:
SUITE 403
Provider Business Mailing Address City Name:
CORPUS CHRISTI
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78411-1882
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-853-7319
Provider Business Mailing Address Fax Number:
361-853-1641

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3301 S ALAMEDA ST
Provider Second Line Business Practice Location Address:
SUITE 403
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78411-1882
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-853-7319
Provider Business Practice Location Address Fax Number:
361-853-1641
Provider Enumeration Date:
07/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
AVET
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
P
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
361-853-7319

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , 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: P088242J6 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: Z00002856 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 079603901 . This is a "MEDICAID TPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8BB570 . This is a "BCBS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 60CP . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 80341S . This is a "BCBS OF TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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