Provider Demographics
NPI:1093145807
Name:CLEAR LAKE EYE CENTER PLLC
Entity Type:Organization
Organization Name:CLEAR LAKE EYE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BRENDING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-338-8474
Mailing Address - Street 1:17040 HIGHWAY 3
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4129
Mailing Address - Country:US
Mailing Address - Phone:281-338-8474
Mailing Address - Fax:281-338-4795
Practice Address - Street 1:17040 HIGHWAY 3
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4129
Practice Address - Country:US
Practice Address - Phone:281-338-8474
Practice Address - Fax:281-338-4795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4230-TG152W00000X
TX7761-TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty