Provider Demographics
NPI:1043414014
Name:TEXAN EYE, PA
Entity Type:Organization
Organization Name:TEXAN EYE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-314-1632
Mailing Address - Street 1:5717 BALCONES DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4203
Mailing Address - Country:US
Mailing Address - Phone:512-327-7000
Mailing Address - Fax:512-314-1662
Practice Address - Street 1:5717 BALCONES DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731
Practice Address - Country:US
Practice Address - Phone:512-327-7000
Practice Address - Fax:512-314-1662
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXAN EYE, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-13
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3889332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
0J22HOtherMEDICARE ID
TX083126501Medicaid
TX083126501Medicaid