Provider Demographics
NPI:1114902442
Name:SOUTHEAST TEXAS EYE SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:SOUTHEAST TEXAS EYE SPECIALISTS, PLLC
Other - Org Name:EYE CENTERS OPTICAL I-10
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGEMENT
Authorized Official - Phone:409-833-0009
Mailing Address - Street 1:3345 PLAZA 10 DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-2554
Mailing Address - Country:US
Mailing Address - Phone:409-833-1314
Mailing Address - Fax:409-833-9039
Practice Address - Street 1:3345 PLAZA 10 DR
Practice Address - Street 2:SUITE B
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-2554
Practice Address - Country:US
Practice Address - Phone:409-833-1314
Practice Address - Fax:409-833-9039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0069CCMedicare PIN
TX1212420001Medicare NSC