Provider Demographics
NPI:1346333036
Name:BROUGHTON ENTERPRISES INC
Entity Type:Organization
Organization Name:BROUGHTON ENTERPRISES INC
Other - Org Name:TEXAS STATE OPTICAL OF LUFKIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-632-1119
Mailing Address - Street 1:905 S JOHN REDDITT DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-4326
Mailing Address - Country:US
Mailing Address - Phone:936-632-1119
Mailing Address - Fax:936-637-7811
Practice Address - Street 1:905 S JOHN REDDITT DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-4326
Practice Address - Country:US
Practice Address - Phone:936-632-1119
Practice Address - Fax:936-637-7811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX16081OtherPROVIDER ID
TX066437701Medicaid
TX23154OtherPROVIDER ID
TX16081OtherPROVIDER ID
TX23154OtherPROVIDER ID