Provider Demographics
NPI:1386230399
Name:MINERAL WELLS EYE CENTER PLLC
Entity Type:Organization
Organization Name:MINERAL WELLS EYE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:940-222-8435
Mailing Address - Street 1:108 FUTURITY LN
Mailing Address - Street 2:
Mailing Address - City:BROCK
Mailing Address - State:TX
Mailing Address - Zip Code:76087-4606
Mailing Address - Country:US
Mailing Address - Phone:559-538-4062
Mailing Address - Fax:
Practice Address - Street 1:601 FM 1821
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067-9119
Practice Address - Country:US
Practice Address - Phone:940-222-8435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-14
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty