Provider Demographics
NPI:1407105679
Name:BRENHAM EYE ASSOCIATES, PA
Entity Type:Organization
Organization Name:BRENHAM EYE ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:HAWS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:979-836-2733
Mailing Address - Street 1:604 HIGHWAY 290W
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-5432
Mailing Address - Country:US
Mailing Address - Phone:979-836-2733
Mailing Address - Fax:979-836-1562
Practice Address - Street 1:604 HIGHWAY 290W
Practice Address - Street 2:SUITE 202
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-5432
Practice Address - Country:US
Practice Address - Phone:979-836-2733
Practice Address - Fax:979-836-1562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4092TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty