Provider Demographics
NPI:1164685988
Name:COMPLETE FAMILY EYECARE
Entity Type:Organization
Organization Name:COMPLETE FAMILY EYECARE
Other - Org Name:EAST TEXAS VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:903-593-2109
Mailing Address - Street 1:510 SSW LOOP 323
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-7678
Mailing Address - Country:US
Mailing Address - Phone:903-593-2109
Mailing Address - Fax:903-593-4799
Practice Address - Street 1:510 SSW LOOP 323
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-7678
Practice Address - Country:US
Practice Address - Phone:903-593-2109
Practice Address - Fax:903-593-4799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3363TG332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier