Provider Demographics
NPI:1124003454
Name:EYE CENTERS OF SOUTHEAST TEXAS LLP
Entity Type:Organization
Organization Name:EYE CENTERS OF SOUTHEAST TEXAS LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-833-0444
Mailing Address - Street 1:PO BOX 7160
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77726-7160
Mailing Address - Country:US
Mailing Address - Phone:409-833-0444
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:409-833-0444
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:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081029301Medicaid
TXCE0997OtherRAILROAD MEDICARE
TXCE0997OtherRAILROAD MEDICARE