Provider Demographics
NPI:1063457786
Name:EYEMASTERS OF TEXAS LTD
Entity Type:Organization
Organization Name:EYEMASTERS OF TEXAS LTD
Other - Org Name:EYEMASTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWCOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-524-6700
Mailing Address - Street 1:PO BOX 848449
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-8449
Mailing Address - Country:US
Mailing Address - Phone:210-524-6663
Mailing Address - Fax:210-524-6587
Practice Address - Street 1:130 NW JOHN JONES DR
Practice Address - Street 2:SUITE 216
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-5152
Practice Address - Country:US
Practice Address - Phone:817-295-4785
Practice Address - Fax:817-295-3283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4806290084Medicare NSC