Provider Demographics
NPI:1154306488
Name:BEAUMONT EYE ASSOCIATES PLLC
Entity Type:Organization
Organization Name:BEAUMONT EYE ASSOCIATES PLLC
Other - Org Name:EYE CENTERS OPTICAL COLLEGE ST.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-838-3725
Mailing Address - Street 1:3220 MILAM ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4754
Mailing Address - Country:US
Mailing Address - Phone:409-838-3725
Mailing Address - Fax:409-832-5372
Practice Address - Street 1:3220 MILAM ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4754
Practice Address - Country:US
Practice Address - Phone:409-838-3725
Practice Address - Fax:409-832-5372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1212420002Medicare NSC
TX0069CCMedicare PIN