Provider Demographics
NPI:1366655854
Name:GULF COAST EYE CENTER, P.A.
Entity Type:Organization
Organization Name:GULF COAST EYE CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:HOYT
Authorized Official - Last Name:LEIDLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-297-4042
Mailing Address - Street 1:117 CIRCLE WAY ST
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5233
Mailing Address - Country:US
Mailing Address - Phone:979-297-4042
Mailing Address - Fax:979-297-4686
Practice Address - Street 1:117 CIRCLE WAY ST
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5233
Practice Address - Country:US
Practice Address - Phone:979-297-4042
Practice Address - Fax:979-297-4686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
TXJ4298261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180036211OtherRAILROAD MEDICARE
TX096931303Medicaid
TX28MVOtherBCBS
TX096931303Medicaid
TX28MVOtherBCBS