Provider Demographics
NPI:1013199736
Name:CONROE VISION ASSOCIATES
Entity Type:Organization
Organization Name:CONROE VISION ASSOCIATES
Other - Org Name:EYELAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:COHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-539-2020
Mailing Address - Street 1:1422 N LOOP 336 W
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3540
Mailing Address - Country:US
Mailing Address - Phone:936-539-2020
Mailing Address - Fax:936-756-7916
Practice Address - Street 1:1422 N LOOP 336 W
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3540
Practice Address - Country:US
Practice Address - Phone:936-539-2020
Practice Address - Fax:936-756-7916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX4217152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5178890001Medicare NSC
TX00253WMedicare PIN
TXU13660Medicare PIN