Provider Demographics
NPI:1063635902
Name:TEXOMA EYE ASSOCIATES LLP
Entity Type:Organization
Organization Name:TEXOMA EYE ASSOCIATES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:ARVIN
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-892-2020
Mailing Address - Street 1:2203 N FM 1417
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-7392
Mailing Address - Country:US
Mailing Address - Phone:903-892-2020
Mailing Address - Fax:903-892-0633
Practice Address - Street 1:2203 N FM 1417
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7392
Practice Address - Country:US
Practice Address - Phone:903-892-2020
Practice Address - Fax:903-892-0633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5338174400000X
207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0060JKOtherBCBS OF TX GROUP
TX156867701Medicaid
TX0060JKOtherBCBS OF TX GROUP
TX4666990001Medicare NSC