Provider Demographics
NPI:1366652828
Name:MAINLAND EYE CLINIC PA
Entity Type:Organization
Organization Name:MAINLAND EYE CLINIC PA
Other - Org Name:MAINLAND EYE CLINIC PA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-534-7141
Mailing Address - Street 1:313 FM 517 RD WEST
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-4009
Mailing Address - Country:US
Mailing Address - Phone:281-534-7141
Mailing Address - Fax:
Practice Address - Street 1:313 FM 517 RD WEST
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-4009
Practice Address - Country:US
Practice Address - Phone:281-534-7141
Practice Address - Fax:281-534-7223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD2990174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142929201Medicaid
89491JMedicare ID - Type Unspecified
TX142929201Medicaid
TXC13790Medicare UPIN
89490JMedicare ID - Type Unspecified