Provider Demographics
NPI:1033649066
Name:BAYBROOK MODERN EYECARE, P.L.L.C
Entity Type:Organization
Organization Name:BAYBROOK MODERN EYECARE, P.L.L.C
Other - Org Name:BAYBROOK MODERN EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SALAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:832-385-0204
Mailing Address - Street 1:1084 BAYBROOK MALL
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-2744
Mailing Address - Country:US
Mailing Address - Phone:281-480-9799
Mailing Address - Fax:281-480-9798
Practice Address - Street 1:1084 BAYBROOK MALL
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-2744
Practice Address - Country:US
Practice Address - Phone:281-480-9799
Practice Address - Fax:281-480-9798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6618TG152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty