Provider Demographics
NPI:1043498116
Name:TEXAS EYE PROSTHETICS LLC
Entity Type:Organization
Organization Name:TEXAS EYE PROSTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR/OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:NELL
Authorized Official - Last Name:DUDASH
Authorized Official - Suffix:
Authorized Official - Credentials:BCO
Authorized Official - Phone:713-524-1001
Mailing Address - Street 1:4203 MONTROSE BLVD STE 380
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-5467
Mailing Address - Country:US
Mailing Address - Phone:713-524-1001
Mailing Address - Fax:713-524-1004
Practice Address - Street 1:4203 MONTROSE BLVD STE 380
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-5467
Practice Address - Country:US
Practice Address - Phone:713-524-1001
Practice Address - Fax:713-524-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5983520001Medicare NSC