Provider Demographics
NPI:1326194242
Name:BUB-LEE EYE CENTER INC
Entity Type:Organization
Organization Name:BUB-LEE EYE CENTER INC
Other - Org Name:SHARP EYES VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRICK
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:BUB
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-991-6774
Mailing Address - Street 1:10411 W FAIRMONT PKWY
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77571-6014
Mailing Address - Country:US
Mailing Address - Phone:281-991-6774
Mailing Address - Fax:832-201-9836
Practice Address - Street 1:10411 W FAIRMONT PKWY
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-6014
Practice Address - Country:US
Practice Address - Phone:281-991-6774
Practice Address - Fax:832-201-9836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00800NMedicare ID - Type Unspecified
TX4140740001Medicare NSC