1487714374 NPI number — CENTRAL TEXAS EYE CLINIC, PA

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 1487714374 NPI number — CENTRAL TEXAS EYE CLINIC, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL TEXAS EYE CLINIC, PA
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:
1487714374
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 21385
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WACO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76702-1385
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-752-8328
Provider Business Mailing Address Fax Number:
254-752-7724

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 W HIGHWAY 6
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
WACO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76710-5591
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-752-8328
Provider Business Practice Location Address Fax Number:
254-752-7724
Provider Enumeration Date:
12/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KANNWISCHER
Authorized Official First Name:
LEWIS
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
254-752-8328

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00DT98 . This is a "MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 082246201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com