Provider Demographics
NPI:1114174315
Name:WOODLANDS EYECARE
Entity Type:Organization
Organization Name:WOODLANDS EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:COPPEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-365-0440
Mailing Address - Street 1:5246 US HIGHWAY 377 S
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KRUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76227-1215
Mailing Address - Country:US
Mailing Address - Phone:940-365-0440
Mailing Address - Fax:940-365-0131
Practice Address - Street 1:5246 US HIGHWAY 377 S
Practice Address - Street 2:SUITE 1
Practice Address - City:KRUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:76227
Practice Address - Country:US
Practice Address - Phone:940-365-0440
Practice Address - Fax:940-365-0131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX800967910152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6273890001Medicare NSC