Provider Demographics
NPI:1134143688
Name:SOUTH TEXAS EYE CONSULTANTS
Entity Type:Organization
Organization Name:SOUTH TEXAS EYE CONSULTANTS
Other - Org Name:EYE CARE OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:DIETZE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-992-9400
Mailing Address - Street 1:2222 MORGAN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78405-1948
Mailing Address - Country:US
Mailing Address - Phone:361-992-9400
Mailing Address - Fax:361-992-8295
Practice Address - Street 1:5402 S STAPLES ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4670
Practice Address - Country:US
Practice Address - Phone:361-992-9400
Practice Address - Fax:361-992-8295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1095930002Medicare NSC