SURGICAL EYE ASSOCIATES, P.A.

Provider Demographics

• NPI: 1043389778
• Name: SURGICAL EYE ASSOCIATES, P.A.
• Entity Type: Organization
• Organization Name: SURGICAL EYE ASSOCIATES, P.A.
• Other - Org Name: VISTA OPTICAL
• Other - Org Type: Other Name
• Authorized Official - Title/Position: PRESIDENT
• Authorized Official - Prefix: DR
• Authorized Official - First Name: PETER
• Authorized Official - Middle Name: SUTHERLAND
• Authorized Official - Last Name: DAWSON
• Authorized Official - Credentials: MD
• Authorized Official - Phone: 713-869-6400
• Mailing Address - Street 1: 1631 NORTH LOOP W
• Mailing Address - Street 2: SUITE 500
• Mailing Address - City: HOUSTON
• Mailing Address - State: TX
• Mailing Address - Zip Code: 77008-1500
• Mailing Address - Country: US
• Mailing Address - Phone: 713-869-6400
• Mailing Address - Fax: 713-869-6498
• Practice Address - Street 1: 1631 NORTH LOOP W
• Practice Address - Street 2: SUITE 500
• Practice Address - City: HOUSTON
• Practice Address - State: TX
• Practice Address - Zip Code: 77008-1500
• Practice Address - Country: US
• Practice Address - Phone: 713-869-6400
• Practice Address - Fax: 713-869-6498
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-11-07
• Last Update Date: 2008-03-07

Provider Licenses

State	License ID	Taxonomies
TX	05253T	152W00000X
TX	03629TG	152W00000X
TX	165108	156FX1800X
TX	158119	156FX1800X
TX	F0436	207W00000X
TX	G8431	207W00000X
TX	G2587	207W00000X
TX	L8692	207W00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207W00000X	Allopathic & Osteopathic Physicians	Ophthalmology		Group - Single Specialty
No	152W00000X	Eye and Vision Services Providers	Optometrist		Group - Single Specialty
No	156FX1800X	Eye and Vision Services Providers	Technician/Technologist	Optician	Group - Single Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
TX	083903701	Medicaid
TX	87V801	Medicare PIN
TX	87V806	Medicare PIN
TX	88092J	Medicare PIN
TX	1048950004	Medicare NSC
TX	00L99S	Medicare PIN
TX	083903701	Medicaid
TX	1048950003	Medicare NSC
TX	8D7053	Medicare PIN
TX	8A6253	Medicare PIN