1679756662 NPI number — MILLS COUNTY EYE CARE P. C.

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 1679756662 NPI number — MILLS COUNTY EYE CARE P. C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILLS COUNTY EYE CARE P. C.
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:
1679756662
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 669
Provider Second Line Business Mailing Address:
1020 FOURTH ST.
Provider Business Mailing Address City Name:
GOLDTHWAITE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76844-0669
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-648-2040
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1020 FOURTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOLDTHWAITE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76844-0669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-648-2040
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BARTEK
Authorized Official First Name:
MELANIE
Authorized Official Middle Name:
CARYNE
Authorized Official Title or Position:
DOCTOR/OWNER
Authorized Official Telephone Number:
325-648-2040

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X , 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)





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