Provider Demographics
NPI:1063831659
Name:DEBORAH ROSE EEZZUDUEMHOI PLLC
Entity Type:Organization
Organization Name:DEBORAH ROSE EEZZUDUEMHOI PLLC
Other - Org Name:SOUTHEAST TEXAS OPHTHALMOLOGY- THE GLAUCOMA CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:EEZZUDUEMHOI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-853-1067
Mailing Address - Street 1:1323 S 27TH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-6257
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1323 S 27TH ST STE 400
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-6257
Practice Address - Country:US
Practice Address - Phone:409-434-0463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3289207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX338434901Medicaid