Provider Demographics
NPI:1356645964
Name:NACOGDOCHES EYE ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:NACOGDOCHES EYE ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:HALBERT
Authorized Official - Last Name:RISNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:936-564-7661
Mailing Address - Street 1:PO BOX 632600
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75963-2600
Mailing Address - Country:US
Mailing Address - Phone:936-564-7661
Mailing Address - Fax:936-564-6622
Practice Address - Street 1:3208 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-2633
Practice Address - Country:US
Practice Address - Phone:936-564-7661
Practice Address - Fax:936-564-6622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-23
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06101TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty