Provider Demographics
NPI:1174842405
Name:BIG COUNTRY OPTICAL, PLLC
Entity Type:Organization
Organization Name:BIG COUNTRY OPTICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETTLY
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:TEAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:325-690-5900
Mailing Address - Street 1:4342 TREANOR DR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602-7012
Mailing Address - Country:US
Mailing Address - Phone:325-690-5900
Mailing Address - Fax:325-690-5902
Practice Address - Street 1:4342 TREANOR DR
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-7012
Practice Address - Country:US
Practice Address - Phone:325-690-5900
Practice Address - Fax:325-690-5902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier