Provider Demographics
NPI:1134133036
Name:REXROAD, DONALD E (OD PC)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:E
Last Name:REXROAD
Suffix:
Gender:M
Credentials:OD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2648 HIGHWAY 36 S
Mailing Address - Street 2:
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-9600
Mailing Address - Country:US
Mailing Address - Phone:979-836-1077
Mailing Address - Fax:979-830-1573
Practice Address - Street 1:2648 HIGHWAY 36 S
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-9600
Practice Address - Country:US
Practice Address - Phone:979-836-1077
Practice Address - Fax:979-830-1573
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2133T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121655801Medicaid
TX0305360001Medicare NSC
TXT15508Medicare UPIN
TX121655801Medicaid