Provider Demographics
NPI:1235222167
Name:PLASTIC EYE SURGERY ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:PLASTIC EYE SURGERY ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROUSSARD
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:713-795-0705
Mailing Address - Street 1:3730 KIRBY DR
Mailing Address - Street 2:SUITE 900
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-3905
Mailing Address - Country:US
Mailing Address - Phone:713-795-0705
Mailing Address - Fax:713-807-0630
Practice Address - Street 1:3730 KIRBY DR
Practice Address - Street 2:SUITE 900
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-3905
Practice Address - Country:US
Practice Address - Phone:713-795-0705
Practice Address - Fax:713-807-0630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0043BMMedicare ID - Type Unspecified