Provider Demographics
NPI:1164421707
Name:EYE DISEASES & LASER SURGERY ASSOCIATED
Entity Type:Organization
Organization Name:EYE DISEASES & LASER SURGERY ASSOCIATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-446-5599
Mailing Address - Street 1:PO BOX 352
Mailing Address - Street 2:
Mailing Address - City:ROCKDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76567-0352
Mailing Address - Country:US
Mailing Address - Phone:512-446-5599
Mailing Address - Fax:512-446-0105
Practice Address - Street 1:305 CHILDRESS DR
Practice Address - Street 2:
Practice Address - City:ROCKDALE
Practice Address - State:TX
Practice Address - Zip Code:76567-2729
Practice Address - Country:US
Practice Address - Phone:512-446-5599
Practice Address - Fax:512-446-0105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-16
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8537207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000CU754Medicaid
TXP000CU754Medicaid
TX00CU75Medicare ID - Type Unspecified