Provider Demographics
NPI:1245238815
Name:MARTIN, WEDEL & BULLARD, P.C.
Entity Type:Organization
Organization Name:MARTIN, WEDEL & BULLARD, P.C.
Other - Org Name:CLEBURNE EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATH
Authorized Official - Middle Name:L
Authorized Official - Last Name:BULLARD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-645-2411
Mailing Address - Street 1:839 N NOLAN RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-7001
Mailing Address - Country:US
Mailing Address - Phone:817-645-2411
Mailing Address - Fax:817-645-3447
Practice Address - Street 1:839 N NOLAN RIVER RD
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-7001
Practice Address - Country:US
Practice Address - Phone:817-645-2411
Practice Address - Fax:817-645-3447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80183QOtherBLUE CROSS BLUE SHIELD
TX81036QOtherBLUE CROSS BLUE SHIELD
TX0065DGOtherBLUE CROSS BLUE SHIELD
TX80286QOtherBLUE CROSS BLUE SHIELD
TX019132201Medicaid
TX80181QOtherBLUE CROSS BLUE SHIELD
TX80182QOtherBLUE CROSS BLUE SHIELD
TX410039049Medicare PIN
TX410039048Medicare PIN
TXP00135354Medicare PIN
TX81036QOtherBLUE CROSS BLUE SHIELD
TX019132201Medicaid
TX88141KMedicare PIN
TX80182QOtherBLUE CROSS BLUE SHIELD
TX88140KMedicare PIN
TX80181QOtherBLUE CROSS BLUE SHIELD
TX80183QOtherBLUE CROSS BLUE SHIELD
TX00563KMedicare PIN
TX410038705Medicare PIN