1669402830 NPI number — SOUTH EAST TEXAS LASER EYE INSTITUTE

Table of content: (NPI 1669402830)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669402830 NPI number — SOUTH EAST TEXAS LASER EYE INSTITUTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH EAST TEXAS LASER EYE INSTITUTE
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:
1669402830
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:
3000 39TH ST
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
PORT ARTHUR
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77642-5517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-985-2745
Provider Business Mailing Address Fax Number:
409-985-2661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 39TH ST
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
PORT ARTHUR
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77642-5517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-985-2745
Provider Business Practice Location Address Fax Number:
409-985-2661
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SINGLA
Authorized Official First Name:
RAJ
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
409-985-2745

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0006HQ . This is a "BLUECROSSBLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com